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De Cassai A, Iuzzolino M, De Pinto S, Zecchino G, Pettenuzzo T, Boscolo A, Biamonte E, Navalesi P, Munari M. Ultrasound mapping of soft tissue vascular anatomy proximal to the larynx: a prospective cohort study. Korean J Anesthesiol 2024:kja.23900. [PMID: 38653329 DOI: 10.4097/kja.23900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Accepted: 04/23/2024] [Indexed: 04/25/2024] Open
Abstract
Background Bleeding incidents during percutaneous dilatational tracheostomy are concerning, and most cases occur in patients with unrecognized and unanticipated anatomical variations in the vascular anatomy. However, the extent of this variation remains unclear. To address this knowledge gap, our study aimed to comprehensively map laryngeal vascular anatomy in a cohort of adult patients. Methods Ultrasound assessments of the soft tissue in the neck were performed, spanning from the thyroid cartilage to the third tracheal ring and extending 2 cm laterally on both sidesperformed. We subdivided this area into 12 zones comprising four medial and eight lateral sections. A pre-planned form was used to document the presence of arteries or veins in each zone. The results are reported as odds ratios, 95% CIs, and corresponding P-values. Results Five-hundred patients were enrolled from August 14, 2023, to November 13, 2023, at the University Hospital of Padua. Arteries and veins were identified in all investigated zones (varying from a minimum of 1.0%-46.4%). The presence of invessels progressively increased from the cricothyroid membrane to the third tracheal ring and from the midline to the paramedian laryngeal area. Conclusions Given the prevalence of arteries and veins, particularly in areas where tracheostomies are commonly performed, we strongly advocate for routine ultrasound assessments before such procedures are performed.
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Affiliation(s)
- Alessandro De Cassai
- Sant'Antonio Anesthesia and Intensive Care Unit, University Hospital of Padova, Padova, Italy
| | - Margherita Iuzzolino
- Sant'Antonio Anesthesia and Intensive Care Unit, University Hospital of Padova, Padova, Italy
| | - Silvia De Pinto
- Sant'Antonio Anesthesia and Intensive Care Unit, University Hospital of Padova, Padova, Italy
| | - Giovanni Zecchino
- Sant'Antonio Anesthesia and Intensive Care Unit, University Hospital of Padova, Padova, Italy
| | - Tommaso Pettenuzzo
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padova, Padova, Italy
| | - Annalisa Boscolo
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padova, Padova, Italy
- Department of Medicine - DIMED, University of Padova, Padova, Italy
- Department of Cardiac, Thoracic, Vascular Sciences, and Public Health, Thoracic Surgery and Lung Transplant Unit, University of Padua, Italy
| | - Eugenio Biamonte
- Department of Medical and Surgical Sciences, Anesthesia and Intensive Care Unit, University Hospital R. Dulbecco, Magna Graecia University, Catanzaro, Italy
| | - Paolo Navalesi
- UOC Anesthesia and Intensive Care Unit, University Hospital of Padova, Padova, Italy
- Department of Medicine - DIMED, University of Padova, Padova, Italy
| | - Marina Munari
- Sant'Antonio Anesthesia and Intensive Care Unit, University Hospital of Padova, Padova, Italy
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Ledl C, Frank U, Dziewas R, Arnold B, Bähre N, Betz CS, Braune S, Deitmer T, Diesener P, Fischer AS, Hamzic S, Iberl G, Konradi J, Löhler J, Platz T, Rohlfes C, Westhoff M, Winkler S, Wirth R, Graf S. [Curriculum " Tracheostomy management in dysphagia therapy"]. HNO 2024:10.1007/s00106-024-01454-7. [PMID: 38578463 DOI: 10.1007/s00106-024-01454-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/06/2024]
Abstract
The number of tracheotomized patients with dysphagia and their need for treatment are continuously increasing in clinical and community settings. The revised version of the directive on home care and community-based intensive care of the Federal Joint Committee (G-BA) requires that tracheotomized patients are regularly evaluated with the aim of identifying and promoting the therapeutic potential after hospital discharge. Dysphagia treatment plays a crucial role as without improvement of severe dysphagia there is practically no possibility for decannulation. Tracheotomized patients with dysphagia are treated by speech and language therapists (SLT); however, the contents of tracheostomy management (TM) are not obligatory in the speech and language therapeutic training curricula, so that there is a need for further education and treatment standards must be secured. Therefore, the German Interdisciplinary Society for Dysphagia (DGD) in cooperation with the participating German medical and therapeutic societies developed a postgraduate curriculum for TM. This should serve as the basis for contents in TM and qualification of therapists within the framework of the delegation of medical services. The goals of the TM curriculum are the definition of theoretical and practical contents of TM, the qualification to perform TM according to current standards of care and quality assurance. The curriculum defines two qualification levels (user and trainer), entry requirements, curricular contents, examination and qualification criteria as well as transitional regulations for SLTs already experienced in TM.
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Affiliation(s)
- C Ledl
- Deutsche interdisziplinäre Gesellschaft für Dysphagie, München, Deutschland.
- Schön Klinik Bad Aibling, Bad Aibling, Deutschland.
| | - U Frank
- Deutsche interdisziplinäre Gesellschaft für Dysphagie, München, Deutschland
- Swallowing Research Lab, Universität Potsdam, Potsdam, Deutschland
| | - R Dziewas
- Deutsche interdisziplinäre Gesellschaft für Dysphagie, München, Deutschland
- Deutsche Gesellschaft für Neurologie, Berlin, Deutschland
- Deutsche Gesellschaft für NeuroIntensiv- und Notfallmedizin, Jena, Deutschland
- Klinik für Neurologie und neurologische Frührehabilitation, Klinikum Osnabrück, Osnabrück, Deutschland
| | - B Arnold
- Deutscher Berufsverband für Phoniatrie und Pädaudiologie, Berlin, Deutschland
| | - N Bähre
- Deutsche Interdisziplinäre Gesellschaft für Außerklinische Beatmung, Freiburg, Deutschland
| | - C S Betz
- Deutsche Gesellschaft für Hals-Nasen-Ohren Heilkunde, Kopf- und Hals-Chirurgie, Bonn, Deutschland
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - S Braune
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, Berlin, Deutschland
- St. Franziskus-Hospital Münster, Münster, Deutschland
| | - T Deitmer
- Deutsche Gesellschaft für Hals-Nasen-Ohren Heilkunde, Kopf- und Hals-Chirurgie, Bonn, Deutschland
| | - P Diesener
- Deutsche Interdisziplinäre Gesellschaft für Außerklinische Beatmung, Freiburg, Deutschland
- Dysphagie-Netzwerk-Südwest e. V., Überlingen, Deutschland
- Dysphagie- und Kanülensprechstunde Hegau-Jugendwerk Gailingen, Gailingen, Deutschland
- Rehaklinik Zihlschlacht, Zihlschlacht-Sitterdorf, Schweiz
| | - A S Fischer
- Juristische Fakultät, Forschungsstelle Medizinrecht, Ludwig-Maximilians-Universität, München, Deutschland
| | - S Hamzic
- Deutscher Bundesverband für akademische Sprachtherapie und Logopädie, Moers, Deutschland
- Universitätsklinikum Gießen und Marburg, Campus Gießen, Neurologische Klinik, Justus-Liebig-Universität, Gießen, Deutschland
| | - G Iberl
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, Berlin, Deutschland
| | - J Konradi
- Deutscher Bundesverband für akademische Sprachtherapie und Logopädie, Moers, Deutschland
- Institut für Physikalische Therapie, Prävention und Rehabilitation, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland
| | - J Löhler
- Deutscher Berufsverband der HNO-Ärzte, Neumünster, Deutschland
| | - T Platz
- Deutsche Gesellschaft für Neurorehabilitation, Berlin, Deutschland
- Institut für Neurorehabilitation und Evidenzbasierung, An-Institut der Universität Greifswald, BDH-Klinik Greifswald, Greifswald, Deutschland
- AG Neurorehabilitation, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - C Rohlfes
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, Berlin, Deutschland
- BDH-Klinik Hessisch Oldendorf, Hessisch Oldendorf, Deutschland
| | - M Westhoff
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, Berlin, Deutschland
- Zentrum für Pneumologie und Thoraxchirurgie, Lungenklinik Hemer, Hemer, Deutschland
| | - S Winkler
- Deutscher Bundesverband für Logopädie, Frechen, Deutschland
| | - R Wirth
- Deutsche Gesellschaft für Geriatrie, Berlin, Deutschland
- Klinik für Altersmedizin, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Bochum, Deutschland
| | - S Graf
- Deutsche interdisziplinäre Gesellschaft für Dysphagie, München, Deutschland
- Deutsche Gesellschaft für Phoniatrie und Pädaudiologie, Göttingen, Deutschland
- Universitätsklinik für Hör‑, Stimm- und Sprachstörungen, Medizinische Universität Innsbruck, Innsbruck, Österreich
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Kiran M, Padala SRAN, Preeti P, Seema S, Kuttan KA. An innovative method of pilot balloon capping for submental intubation. J Dent Anesth Pain Med 2024; 24:139-141. [PMID: 38584759 PMCID: PMC10995542 DOI: 10.17245/jdapm.2024.24.2.139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Revised: 03/03/2024] [Accepted: 03/05/2024] [Indexed: 04/09/2024] Open
Affiliation(s)
- Molli Kiran
- Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | | | - Preeti Preeti
- Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS), Bhopal, India
| | - Seema Seema
- Department of Anaesthesiology, All India Institute of Medical Sciences (AIIMS), Bhopal, India
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Pons-Tomàs G, Painamil RM, Campos SR, Arasa EP, Sanflorencio LP, Corredor LP, López IT. Characteristics of tracheostomized patients followed up by a Palliative Care and Complex Chronic Patient Service. An Pediatr (Barc) 2024; 100:251-258. [PMID: 38604934 DOI: 10.1016/j.anpede.2024.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 12/13/2023] [Indexed: 04/13/2024] Open
Abstract
INTRODUCTION AND OBJECTIVES In recent years, there has been an increase in the number of children with tracheostomies. The objective was to describe the characteristics of paediatric patients with a tracheostomy followed up by the Department of Palliative Care and Chronic Medically Complex Illness (DPCCMCI) of a tertiary care hospital. METHODS Single-centre retrospective observational study in patients aged less than 18 years with a tracheostomy followed up by the PCCCPS of a tertiary care hospital (November 2020-June 2022). We analysed epidemiological, clinical, microbiological and social data by reviewing the health records. RESULTS The sample included 44 tracheostomized patients. The most frequent underlying disease was acquired upper airway disease (20.5%). The most common indication for tracheostomy was upper airway obstruction (66%). Bacterial isolates were detected in 84% of the tracheal aspirates, among which P. aeruginosa was the most frequent (56.8%). The most frequently prescribed antibiotic was ciprofloxacin (84%). In addition, 18.1% of the patients received at least 1 course of intravenous antibiotherapy and 29.5% received more than 3 systemic antibiotic regimens in the past 20 months. Fifty-nine percent of the children were schooled: 38.6% attended a regular school, 15.9% a special needs school and 4.5% were home-schooled. We identified social difficulties in 53.7%. Also, 22.7% of the families received financial support to care for a child with severe illness. CONCLUSIONS Because of the complexity of caring for tracheostomized children, integral and coordinated management is essential. Schooling is possible and safe if caregivers are trained.
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Affiliation(s)
- Gemma Pons-Tomàs
- Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Spain
| | | | - Sílvia Ricart Campos
- Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Spain; Servicio de Atención Paliativa y Paciente crónico Complejo (C2P2), Hospital Sant Joan de Déu, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Eduard Pellicer Arasa
- Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Lucía Peñarrubia Sanflorencio
- Servicio de Atención Paliativa y Paciente crónico Complejo (C2P2), Hospital Sant Joan de Déu, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Laura Ponce Corredor
- Servicio de Atención Paliativa y Paciente crónico Complejo (C2P2), Hospital Sant Joan de Déu, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Barcelona, Spain
| | - Isabel Torrús López
- Servicio de Pediatría, Hospital Sant Joan de Déu, Barcelona, Spain; Servicio de Atención Paliativa y Paciente crónico Complejo (C2P2), Hospital Sant Joan de Déu, Barcelona, Spain; Institut de Recerca Sant Joan de Déu, Barcelona, Spain.
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Lloyd AM, Behzadpour HK, Rana MS, Espinel AG. Time considerations and outcomes in pediatric tracheostomy decannulation. Int J Pediatr Otorhinolaryngol 2024; 179:111934. [PMID: 38537449 DOI: 10.1016/j.ijporl.2024.111934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/06/2024] [Accepted: 03/24/2024] [Indexed: 04/14/2024]
Abstract
OBJECTIVE The study objective is to identify factors that impact the time to decannulation in pediatric patients ages 0 through 18 years who are tracheostomy-dependent. METHODS This retrospective chart review from January 1, 2005 through December 31, 2020 identified pediatric tracheostomy patients at a single pediatric institution. Data extracted included demographic, socioeconomic factors, and clinical characteristics. Multivariate regression and survival analysis were used to identify factors associated with successful decannulation and decreased time with tracheostomy. RESULTS Of the 479 tracheostomy-dependent patients identified, 162 (33.8%) were decannulated. Time to decannulation ranged from 0.5 months to 189.2 months with median of 24 months (IQR 12.91-45.71). In the multivariate analysis, patients with bronchopulmonary dysplasia (p = 0.021) and those with Passy-Muir® Valve at discharge (p = 0.015) were significantly associated with decannulation. In contrast, neurologic comorbidities (p = 0.06), presence of gastrostomy tube (p < 0.001), or discharged on a home ventilator (p < 0.001) were associated with indefinite tracheostomy. When adjusting for age, sex, race, ethnicity, and insurance status, for every one month delay in establishment of outpatient otolaryngology care, time to decannulation was delayed by 0.5 months (p = 0.010). For each additional outpatient otolaryngology follow-up visit, time to decannulation increased by 3.36 months (p < 0.001). CONCLUSIONS Decannulation in pediatric tracheostomy patients is multifactorial. While timely establishment of outpatient care did correlate with quicker decannulation, factors related to medical complexity may have a greater impact on time to decannulation. Our results can help guide institutional decannulation protocols, as well as provide guidance when counseling families regarding tracheostomy expectations.
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Affiliation(s)
- Ashley M Lloyd
- Division of Otolaryngology, George Washington University Hospital, Washington, DC, USA.
| | - Hengameh K Behzadpour
- Division of Pediatric Otolaryngology, Children's National Hospital, Washington, DC, USA
| | - Md Sohel Rana
- Department of Surgery, Children's National Hospital, Washington DC, USA
| | - Alexandra G Espinel
- Division of Pediatric Otolaryngology, Children's National Hospital, Washington, DC, USA
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Azari Jafari A, Mirmoeeni S, Momtaz D, Kotzur T, Murtha G, Garcia C, Moran M, Martinez P, Chen K, Krishnakumar H, Seifi A. Early Versus Late Tracheostomy in Patients with Traumatic Brain Injury: A US Nationwide Analysis. Neurocrit Care 2024; 40:551-561. [PMID: 37415023 DOI: 10.1007/s12028-023-01778-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/06/2023] [Indexed: 07/08/2023]
Abstract
BACKGROUND One of the most critical issues in patients suffering from traumatic brain injury (TBI) is protecting the airway and attempting to keep a secure airway. It is evident that tracheostomy in patients with TBI after 7-14 days can have favorable outcomes if the patient cannot be extubated; however, some clinicians have recommended early tracheostomy before 7 days. METHODS A retrospective cohort of inpatient study participants was queried from the National Inpatient Sample to include patients with TBI between 2016 and 2020 undergoing tracheostomy and outcomes between the two groups of early tracheostomy (ET) (< 7 days from admission) and late tracheostomy (LT) (≥ 7 days from admission) were compared. RESULTS We reviewed 219,005 patients with TBI, out of whom 3.04% had a tracheostomy. Patients in the ET group were younger than those in the LT group (45.02 ± 19.38 years old vs. 48.68 ± 20.50 years old, respectively, p < 0.001), mainly men (76.64% vs. 73.73%, respectively, p = 0.01), and mainly White race (59.88% vs. 57.53%, respectively, p = 0.33). The patients in the ET group had a significantly shorter length of stay as compared with those in the LT group (27.78 ± 25.96 days vs. 36.32 ± 29.30 days, respectively, p < 0.001) and had a significantly lower hospital charge ($502,502.436 ± 427,060.81 vs. $642,739.302 ± 516,078.94 per patient, respectively, p < 0.001). The whole TBI cohort mortality was reported at 7.04%, which was higher within the ET group compared with the LT group (8.69% vs. 6.07%, respectively, p < 0.001). Patients in the LT had higher odds of developing any infection (odds ratio [OR] 1.43 [1.22-1.68], p < 0.001), emerging sepsis (OR 1.61 [1.39-1.87], p < 0.001), pneumonia (OR 1.52 [1.36-1.69], p < 0.001), and respiratory failure (OR 1.30 [1.09-1.55], p = 0.004). CONCLUSIONS This study shows that ET can provide notable and significant benefits for patients with TBI. Future high-quality prospective studies should be performed to investigate and shed more light on the ideal timing of tracheostomy in patients with TBI.
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Affiliation(s)
- Amirhossein Azari Jafari
- Student Research Committee, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
| | | | - David Momtaz
- School of Medicine, University of Texas Health Science Center at San Antonio School of Medicine, San Antonio, TX, USA
| | - Travis Kotzur
- School of Medicine, University of Texas Health Science Center at San Antonio School of Medicine, San Antonio, TX, USA
| | - Gregory Murtha
- Department of Neurosurgery, Division of Neuro Critical Care, University of Texas Health Science Center at San Antonio School of Medicine, 7033 Floyd Curl Drive, Mail code 7843, San Antonio, TX, 78299, USA
| | - Carlos Garcia
- Department of Neurosurgery, Division of Neuro Critical Care, University of Texas Health Science Center at San Antonio School of Medicine, 7033 Floyd Curl Drive, Mail code 7843, San Antonio, TX, 78299, USA
| | - Maggie Moran
- Department of Neurosurgery, Division of Neuro Critical Care, University of Texas Health Science Center at San Antonio School of Medicine, 7033 Floyd Curl Drive, Mail code 7843, San Antonio, TX, 78299, USA
| | - Paola Martinez
- Department of Neurosurgery, Division of Neuro Critical Care, University of Texas Health Science Center at San Antonio School of Medicine, 7033 Floyd Curl Drive, Mail code 7843, San Antonio, TX, 78299, USA
| | - Kevin Chen
- Department of Neurosurgery, Division of Neuro Critical Care, University of Texas Health Science Center at San Antonio School of Medicine, 7033 Floyd Curl Drive, Mail code 7843, San Antonio, TX, 78299, USA
| | - Hari Krishnakumar
- School of Medicine, University of Texas Health Science Center at San Antonio School of Medicine, San Antonio, TX, USA
| | - Ali Seifi
- Department of Neurosurgery, Division of Neuro Critical Care, University of Texas Health Science Center at San Antonio School of Medicine, 7033 Floyd Curl Drive, Mail code 7843, San Antonio, TX, 78299, USA.
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Karnina R, Sugiarto A, Sedono R, Aditianingsih D, Manggala SK, Purwaamidjaja DB. Decision for early tracheostomy in respiratory failure of a paralyzed myasthenia gravis patient with sepsis-induced pneumonia: A case report. Int J Surg Case Rep 2024; 117:109514. [PMID: 38479127 PMCID: PMC10945206 DOI: 10.1016/j.ijscr.2024.109514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Revised: 03/04/2024] [Accepted: 03/07/2024] [Indexed: 03/21/2024] Open
Abstract
INTRODUCTION The neuromuscular condition myasthenia gravis (MG) can make treating sepsis-induced pneumonia more challenging. Since these patients risk respiratory failure, decisions about airway treatment, including tracheostomy, can be difficult. We report a case of a patient with sepsis and concurrent MG who underwent an early tracheostomy due to acute respiratory failure. PRESENTATION OF CASE A 44-year-old woman with a history of MG presented to the emergency department with a stiff tongue, hypersalivation, limb paralysis and a phlegmy cough causing severe respiratory distress, aggravated by community-acquired pneumonia. A chest X-ray showed extensive infiltration and consolidation in the lower lobes. The patient was transferred immediately to the intensive care unit on mechanical ventilation. Despite initial treatment with antibiotics and respiratory support, her mental and respiratory status deteriorated rapidly. Given the risk of myasthenic crisis, sepsis and impending respiratory failure, with anticipated lengthy ventilator utilization and hospitalization, a multidisciplinary team decided to perform an early tracheostomy. DISCUSSION The early tracheostomy procedure was carried out securely on the third day of hospitalization. This allowed for better pulmonary hygiene, adequate ventilation, airway clearance and rehabilitation therapy. The family contributed to stoma care and breathing exercises. The patient's respiratory condition steadily improved over the following weeks. The cough reflex remained well, and mechanical ventilation was gradually weaned off. CONCLUSION Early tracheostomy in a paralyzed MG patient with sepsis-induced pneumonia can improve clinical outcomes and optimize airway management.
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Affiliation(s)
- Resiana Karnina
- Trainee of Intensive Care Fellowship Program, Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Ciptomangunkusumo Hospital, Jakarta, Indonesia; Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Muhammadiyah Jakarta, Jakarta, Indonesia.
| | - Adhrie Sugiarto
- Intensive Care Consultant, Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Ciptomangunkusumo Hospital, Jakarta, Indonesia
| | - Rudyanto Sedono
- Intensive Care Consultant, Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Ciptomangunkusumo Hospital, Jakarta, Indonesia
| | - Dita Aditianingsih
- Intensive Care Consultant, Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Ciptomangunkusumo Hospital, Jakarta, Indonesia
| | - Sidharta Kusuma Manggala
- Intensive Care Consultant, Department of Anesthesiology and Intensive Care, Faculty of Medicine, Universitas Indonesia, Ciptomangunkusumo Hospital, Jakarta, Indonesia
| | - Dis Bima Purwaamidjaja
- Intensive Care Consultant, Department of Anesthesiology and Intensive Care, Gatot Soebroto Army Central Hospital, Jakarta, Indonesia
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8
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Ledl C, Frank U, Dziewas R, Arnold B, Bähre N, Betz CS, Braune S, Deitmer T, Diesener P, Fischer AS, Hamzic S, Iberl G, Konradi J, Löhler J, Platz T, Rohlfes C, Westhoff M, Winkler S, Wirth R, Graf S. [Curriculum " Tracheostomy management in dysphagia therapy"]. Nervenarzt 2024; 95:342-352. [PMID: 38277047 PMCID: PMC11014872 DOI: 10.1007/s00115-023-01598-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 12/05/2023] [Indexed: 01/27/2024]
Abstract
The number of tracheotomized patients with dysphagia and their need for treatment are continuously increasing in clinical and community settings. The revised version of the directive on home care and community-based intensive care of the Federal Joint Committee (G-BA) requires that tracheotomized patients are regularly evaluated with the aim of identifying and promoting the therapeutic potential after hospital discharge. Dysphagia treatment plays a crucial role as without improvement of severe dysphagia there is practically no possibility for decannulation. Tracheotomized patients with dysphagia are treated by speech and language therapists (SLT); however, the contents of tracheostomy management (TM) are not obligatory in the speech and language therapeutic training curricula, so that there is a need for further education and treatment standards must be secured. Therefore, the German Interdisciplinary Society for Dysphagia (DGD) in cooperation with the participating German medical and therapeutic societies developed a postgraduate curriculum for TM. This should serve as the basis for contents in TM and qualification of therapists within the framework of the delegation of medical services. The goals of the TM curriculum are the definition of theoretical and practical contents of TM, the qualification to perform TM according to current standards of care and quality assurance. The curriculum defines two qualification levels (user and trainer), entry requirements, curricular contents, examination and qualification criteria as well as transitional regulations for SLTs already experienced in TM.
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Affiliation(s)
- C Ledl
- Deutsche interdisziplinäre Gesellschaft für Dysphagie, München, Deutschland.
- Schön Klinik Bad Aibling, Bad Aibling, Deutschland.
| | - U Frank
- Deutsche interdisziplinäre Gesellschaft für Dysphagie, München, Deutschland
- Swallowing Research Lab, Universität Potsdam, Potsdam, Deutschland
| | - R Dziewas
- Deutsche interdisziplinäre Gesellschaft für Dysphagie, München, Deutschland
- Deutsche Gesellschaft für Neurologie, Berlin, Deutschland
- Deutsche Gesellschaft für NeuroIntensiv- und Notfallmedizin, Jena, Deutschland
- Klinik für Neurologie und neurologische Frührehabilitation, Klinikum Osnabrück, Osnabrück, Deutschland
| | - B Arnold
- Deutscher Berufsverband für Phoniatrie und Pädaudiologie, Berlin, Deutschland
| | - N Bähre
- Deutsche Interdisziplinäre Gesellschaft für Außerklinische Beatmung, Freiburg, Deutschland
| | - C S Betz
- Deutsche Gesellschaft für Hals-Nasen-Ohren Heilkunde, Kopf- und Hals-Chirurgie, Bonn, Deutschland
- Klinik und Poliklinik für HNO-Heilkunde, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Deutschland
| | - S Braune
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, Berlin, Deutschland
- St. Franziskus-Hospital Münster, Münster, Deutschland
| | - T Deitmer
- Deutsche Gesellschaft für Hals-Nasen-Ohren Heilkunde, Kopf- und Hals-Chirurgie, Bonn, Deutschland
| | - P Diesener
- Deutsche Interdisziplinäre Gesellschaft für Außerklinische Beatmung, Freiburg, Deutschland
- Dysphagie-Netzwerk-Südwest e. V., Überlingen, Deutschland
- Dysphagie- und Kanülensprechstunde Hegau-Jugendwerk Gailingen, Gailingen, Deutschland
- Rehaklinik Zihlschlacht, Zihlschlacht-Sitterdorf, Schweiz
| | - A S Fischer
- Juristische Fakultät, Forschungsstelle Medizinrecht, Ludwig-Maximilians-Universität, München, Deutschland
| | - S Hamzic
- Deutscher Bundesverband für akademische Sprachtherapie und Logopädie, Moers, Deutschland
- Universitätsklinikum Gießen und Marburg, Campus Gießen, Neurologische Klinik, Justus-Liebig-Universität, Gießen, Deutschland
| | - G Iberl
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, Berlin, Deutschland
| | - J Konradi
- Deutscher Bundesverband für akademische Sprachtherapie und Logopädie, Moers, Deutschland
- Institut für Physikalische Therapie, Prävention und Rehabilitation, Universitätsmedizin der Johannes-Gutenberg-Universität Mainz, Mainz, Deutschland
| | - J Löhler
- Deutscher Berufsverband der HNO-Ärzte, Neumünster, Deutschland
| | - T Platz
- Deutsche Gesellschaft für Neurorehabilitation, Berlin, Deutschland
- Institut für Neurorehabilitation und Evidenzbasierung, An-Institut der Universität Greifswald, BDH-Klinik Greifswald, Greifswald, Deutschland
- AG Neurorehabilitation, Universitätsmedizin Greifswald, Greifswald, Deutschland
| | - C Rohlfes
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, Berlin, Deutschland
- BDH-Klinik Hessisch Oldendorf, Hessisch Oldendorf, Deutschland
| | - M Westhoff
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin, Berlin, Deutschland
- Zentrum für Pneumologie und Thoraxchirurgie, Lungenklinik Hemer, Hemer, Deutschland
| | - S Winkler
- Deutscher Bundesverband für Logopädie, Frechen, Deutschland
| | - R Wirth
- Deutsche Gesellschaft für Geriatrie, Berlin, Deutschland
- Klinik für Altersmedizin, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Bochum, Deutschland
| | - S Graf
- Deutsche interdisziplinäre Gesellschaft für Dysphagie, München, Deutschland
- Deutsche Gesellschaft für Phoniatrie und Pädaudiologie, Göttingen, Deutschland
- Universitätsklinik für Hör‑, Stimm- und Sprachstörungen, Medizinische Universität Innsbruck, Innsbruck, Österreich
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9
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Rose L, Messer B. Prolonged Mechanical Ventilation, Weaning, and the Role of Tracheostomy. Crit Care Clin 2024; 40:409-427. [PMID: 38432703 DOI: 10.1016/j.ccc.2024.01.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/05/2024]
Abstract
Depending on the definitional criteria used, approximately 5% to 10% of critical adults will require prolonged mechanical ventilation with longer-term outcomes that are worse than those ventilated for a shorter duration. Outcomes are affected by patient characteristics before critical illness and its severity but also by organizational characteristics and care models. Definitive trials of interventions to inform care activities, such as ventilator weaning, upper airway management, rehabilitation, and nutrition specific to the prolonged mechanical ventilation patient population, are lacking. A structured and individualized approach developed by the multiprofessional team in discussion with the patient and their family is warranted.
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Affiliation(s)
- Louise Rose
- Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, 57 Waterloo Road, London SE1 8WA, UK; Department of Critical Care and Lane Fox Unit, Guy's & St Thomas' NHS Foundation Trust, King's College London, 57 Waterloo Road, London SE1 8WA, UK.
| | - Ben Messer
- Royal Victoria Infirmary, Newcastle-Upon-Tyne NHS Hospitals NHS Foundation Trust, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK
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10
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Gao L, Chang Y, Lu S, Liu X, Yao X, Zhang W, Sun E. A nomogram for predicting the necessity of tracheostomy after severe acute brain injury in patients within the neurosurgery intensive care unit: A retrospective cohort study. Heliyon 2024; 10:e27416. [PMID: 38509924 PMCID: PMC10951500 DOI: 10.1016/j.heliyon.2024.e27416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 02/15/2024] [Accepted: 02/28/2024] [Indexed: 03/22/2024] Open
Abstract
Objective This retrospective study was aimed to develop a predictive model for assessing the necessity of tracheostomy (TT) in patients admitted to the neurosurgery intensive care unit (NSICU). Method We analyzed data from 1626 NSICU patients with severe acute brain injury (SABI) who were admitted to the Department of NSICU at the Affiliated People's Hospital of Jiangsu University between January 2021 and December 2022. Data of the patients were retrospectively obtained from the clinical research data platform. The patients were randomly divided into training (70%) and testing (30%) cohorts. The least absolute shrinkage and selection operator (LASSO) regression identified the optimal predictive features. A multivariate logistic regression model was then constructed and represented by a nomogram. The efficacy of the model was evaluated based on discrimination, calibration, and clinical utility. Results The model highlighted six predictive variables, including the duration of NSICU stay, neurosurgery, orotracheal intubation time, Glasgow Coma Scale (GCS) score, systolic pressure, and respiration rate. Receiver operating characteristic (ROC) analysis of the nomogram yielded area under the curve (AUC) values of 0.854 (95% confidence interval [CI]: 0.822-0.886) for the training cohort and 0.865 (95% CI: 0.817-0.913) for the testing cohort, suggesting commendable differential performance. The predictions closely aligned with actual observations in both cohorts. Decision curve analysis demonstrated that the numerical model offered a favorable net clinical benefit. Conclusion We developed a novel predictive model to identify risk factors for TT in SABI patients within the NSICU. This model holds the potential to assist clinicians in making timely surgical decisions concerning TT.
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Affiliation(s)
- Liqin Gao
- Department of Neurosurgical Intensive Care Unit, Affiliated People's Hospital of Jiangsu University, ZhenJiang, Jiangsu Province, 212002, China
| | - Yafen Chang
- Department of Neurosurgical Intensive Care Unit, Affiliated People's Hospital of Jiangsu University, ZhenJiang, Jiangsu Province, 212002, China
| | - Siyuan Lu
- Department of Radiology, Affiliated People's Hospital of Jiangsu University, ZhenJiang, Jiangsu Province, 212002, China
| | - Xiyang Liu
- Jiangsu University, ZhenJiang, Jiangsu Province, 212002, China
| | - Xiang Yao
- Department of Orthopaedics, Affiliated People's Hospital of Jiangsu University, ZhenJiang, Jiangsu Province, 212002, China
| | - Wei Zhang
- Jiangsu University, ZhenJiang, Jiangsu Province, 212002, China
| | - Eryi Sun
- Department of Neurosurgery, Affiliated People's Hospital of Jiangsu University, ZhenJiang, Jiangsu Province, 212002, China
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11
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Azurdia AR, Walters J, Mellon CR, Lettieri SC, Kopelman TR, Pieri P, Feiz-Erfan I. Airway risk associated with patients in halo fixation. Surg Neurol Int 2024; 15:104. [PMID: 38628525 PMCID: PMC11021081 DOI: 10.25259/sni_386_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2023] [Accepted: 12/30/2023] [Indexed: 04/19/2024] Open
Abstract
Background The halo fixation device introduces a significant obstacle for clinicians attempting to secure a definitive airway in trauma patients with cervical spine injuries. The authors sought to determine the airway-related mortality rate of adult trauma patients in halo fixation requiring endotracheal intubation. Methods This study was a retrospective chart review of patients identified between 2007 and 2012. Only adult trauma patients who were intubated while in halo fixation were included in the study. Results A total of 46 patients underwent 60 intubations while in halo. On five occasions, (8.3%) patients were unable to be intubated and required an emergent surgical airway. Two (4.4%) of the patients out of our study population died specifically due to airway complications. Elective intubations had a failure rate of 5.8% but had no related permanent morbidity or mortality. In contrast to that, 25% of non-elective intubations failed and resulted in the deaths of two patients. The association between mortality and non-elective intubations was statistically highly significant (P = 0.0003). Conclusion The failed intubation and airway-related mortality rates of patients in halo fixation were substantial in this study. This finding suggests that the halo device itself may present a major obstacle in airway management. Therefore, heightened vigilance is appropriate for intubations of patients in halo fixation.
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Affiliation(s)
- Adrienne R. Azurdia
- Department of Emergency Medicine, HonorHealth Osborn, Scottsdale, United States
| | - Jarvis Walters
- Department of Surgery, Division of Trauma, Valleywise Health Medical Center, Phoenix, United States
| | - Chris R. Mellon
- Department of Trauma Surgery and Surgical Critical Care, HonorHealth Osborn, Phoenix, United States
| | - Salvatore C. Lettieri
- Department of Surgery, Division of Plastic Surgery, Valleywise Health Medical Center, Phoenix, United States
| | - Tammy R. Kopelman
- Department of Surgery, Division of Trauma, Valleywise Health Medical Center, Phoenix, United States
| | - Paola Pieri
- Department of Surgery, Division of Trauma, Valleywise Health Medical Center, Phoenix, United States
| | - Iman Feiz-Erfan
- Department of Surgery, Division of Neurosurgery, Valleywise Health Medical Center, Phoenix, United States
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12
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Asayama R, Tanaka-Nishikubo K, Okada M, Mukai N, Annen S, Matsumoto H, Takeba J, Sato N, Hato N. Dysphagia in patients with severe COVID-19: a retrospective study. Sci Rep 2024; 14:6829. [PMID: 38514734 PMCID: PMC10957916 DOI: 10.1038/s41598-024-57508-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 03/19/2024] [Indexed: 03/23/2024] Open
Abstract
To investigate dysphagia after extubation in patients with severe coronavirus disease 2019 (COVID-19). We retrospectively examined patients with severe COVID-19 treated in our hospital between August 2021 and March 2022. Feeding outcomes were categorized into two groups-(1) total oral intake, and (2) difficulty in oral intake. To assess the feeding outcome, we used modified water-swallowing test (MWST) for all patients. However, in cases where aspiration or recurrent laryngeal nerve palsy was suspected, we conducted the fiberoptic endoscopic evaluation of swallowing after MWST. Patient data were collected from medical records. Forty-six patients with severe COVID-19 were included. Among the 46 patients, 14 (30.4%) experienced difficulties with oral intake. Older age, longer length of hospitalization, duration of mechanical ventilation, tracheostomy, diabetes, and higher serum levels of C-reactive protein (CRP) and procalcitonin (PCT) at the time of intubation were associated with difficulty in oral intake. The rate of difficulty with oral intake in patients with severe COVID-19 was 30.4%, which is not as high as reported in previous studies. Older age, longer duration of mechanical ventilation, tracheostomy, diabetes, and higher levels of CRP and PCT were associated with the prevalence of oral intake difficulty, suggesting that early attention should be paid to high-risk patients who have preexisting deterioration of swallowing function due to aging and comorbidities, or who have prolonged intubation or tracheostomy to prevent aspiration pneumonia.
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Affiliation(s)
- Rie Asayama
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan.
| | - Kaori Tanaka-Nishikubo
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Masahiro Okada
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Naoki Mukai
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Suguru Annen
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Hironori Matsumoto
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Jun Takeba
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Norio Sato
- Department of Emergency and Critical Care Medicine, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Naohito Hato
- Department of Otolaryngology, Head and Neck Surgery, Ehime University Graduate School of Medicine, Shitsukawa, Toon, Ehime, 791-0295, Japan
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13
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Kobayashi M, Hirai M, Suzuki M, Sasaki A. Tracheostomy for the pediatric patient with fibrodysplasia ossificans progressiva: a case report. Surg Case Rep 2024; 10:61. [PMID: 38485853 PMCID: PMC10940568 DOI: 10.1186/s40792-024-01864-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 03/09/2024] [Indexed: 03/18/2024] Open
Abstract
BACKGROUND Fibrodysplasia ossificans progressiva (FOP) is an extremely rare connective tissue disease characterized by subsequent ossification of skeletal muscles, tendons, ligaments, and other fibrous tissues. The ossification of these tissues progresses during childhood and leads to limb and trunk deformities. Since any surgery may trigger subsequent ossification, it is relatively contraindicated for patients with FOP. In this report, we describe our experience in performing tracheostomy in a pediatric patient with FOP who developed a restrictive respiratory disorder due to progressive deformity of the trunk. CASE PRESENTATION A 12-year-old boy, diagnosed with FOP at the age of one, was referred for a tracheotomy after requiring 2 months of oral intubation and mechanical ventilation due to severe deformity-induced dyspnea. After changing from oral intubation to nasal intubation, we carefully considered the indications and benefits of tracheostomy in patients with FOP. Eventually, tracheostomy was successfully performed using our surgical design: creating a skin incision at the level of the cricoid cartilage that can always be identified, creating inverted U-shaped incision on the anterior tracheal wall to make a flap, and suturing the entire circumference of the tracheotomy and skin. One month after the surgery, he regained normal breathing and pronunciation and returned to school. The patient showed no unfavorable postoperative outcomes over a 4-year follow-up period. CONCLUSIONS Tracheostomy in our pediatric case of FOP required careful perioperative management. However, it could effectively improve the patient's quality of life.
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Affiliation(s)
- Megumi Kobayashi
- Department of Surgery, School of Medicine, Iwate Medical University, 2-1-1 Idaidouri, Yahaba, Shiwa, Iwate, 028-3695, Japan.
| | - Misako Hirai
- Ibaraki Welfare and Medical Center, 1872-1 Motoyoshida, Mito, Ibaraki, 310-0836, Japan
| | - Makoto Suzuki
- Department of Surgery, School of Medicine, Iwate Medical University, 2-1-1 Idaidouri, Yahaba, Shiwa, Iwate, 028-3695, Japan
| | - Akira Sasaki
- Department of Surgery, School of Medicine, Iwate Medical University, 2-1-1 Idaidouri, Yahaba, Shiwa, Iwate, 028-3695, Japan
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14
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Tang S, Lin G, Wu X, Chen Z. SARS-CoV-2 infection increases airway bleeding risk in patients after tracheostomies. Virol J 2024; 21:61. [PMID: 38454485 PMCID: PMC10921690 DOI: 10.1186/s12985-024-02320-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 02/19/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND Airway bleeding events are a rare incident in SARS-CoV-2-infected patients after tracheostomies. We aimed to explore the correlation between airway bleeding and SARS-CoV-2 infection and evaluate the consistency of SARS-CoV-2 RNA test results in the upper and lower airway samples from patients after tracheostomies. METHODS Forty-four patients after temporary or permanent tracheostomy were divided into a positive group (29 patients) and a negative group (15 patients) based on the SARS-CoV-2 RNA test results of their oropharyngeal swabs. The oropharyngeal and tracheal swabs of the positive group were re-collected for SARS-CoV-2 RNA detection. Demographic and clinical characteristics and airway bleeding events were recorded for all enrolled patients. RESULTS Airway bleeding was reported in eleven patients of the positive group (11/29), with seven displaying bloody sputum or hemoptysis, and four featuring massive sputum crust formation in the trachea that resulted in dyspnea, and only one patient in the negative group (1/15), with a significant difference in the airway bleeding rate (37.9% vs. 6.7%, p < 0.05). The SARS-CoV-2 RNA test results showed a statistical difference in cycle threshold (Ct) values between oropharyngeal swabs and tracheal swabs (p < 0.05). CONCLUSIONS After tracheostomies, patients are more susceptible to airway bleeding if they are infected with SARS-CoV-2. The findings signify that in addition to droplet transmission through tracheostoma, SARS-CoV-2 may infect the oropharynx by airborne and close contact transmission, and that given the higher viral load and longer infection time in the trachea, tracheal swabs are more reliable for SARS-CoV-2 detection in these patients.
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Affiliation(s)
- Shupin Tang
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Otorhinolaryngology Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
- Fujian Institute of Otorhinolaryngology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Gongbiao Lin
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
- Department of Otorhinolaryngology Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China.
- Fujian Institute of Otorhinolaryngology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China.
| | - Xiaobo Wu
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Otorhinolaryngology Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
- Fujian Institute of Otorhinolaryngology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
| | - Zhihong Chen
- Department of Otorhinolaryngology Head and Neck Surgery, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
- Department of Otorhinolaryngology Head and Neck Surgery, National Regional Medical Center, Binhai Campus of the First Affiliated Hospital, Fujian Medical University, Fuzhou, 350212, China
- Fujian Institute of Otorhinolaryngology, The First Affiliated Hospital, Fujian Medical University, Fuzhou, 350005, China
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15
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Alvi S, Blackwell T, Curran NR, Germanwala A. Comparative impact of COVID-19 infection on tracheostomy patients. Am J Otolaryngol 2024; 45:104112. [PMID: 38039914 DOI: 10.1016/j.amjoto.2023.104112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 10/29/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE We study outcomes after tracheostomy in COVID-19 positive patients versus COVID-19 negative patients who underwent tracheostomy during the same time frame in an effort to better understand the influence of COVID-19 despite variances in virus strain and treatment practices. MATERIALS AND METHODS This is a retrospective cohort study of all Veterans Affairs centers nationwide, using data provided by the Veterans Affairs Informatics and Computing Infrastructure. Our cohort consisted of veteran patients who underwent tracheostomy between March 2020 and September 2022. Patients who tested positive for COVID-19 within three months prior to tracheostomy were compared to patients who had never tested positive for COVID-19. RESULTS 956 patients were included in the analysis, and nearly 96 % of these patients were male. The COVID-19 positive group spent one more week on the ventilator and experienced lower rates of successful ventilator weaning (hazard ratio 0.74, 95 % confidence interval [0.62, 0.88], P < 0.001). Survival curves were non-proportional, and while the COVID-19 positive group had higher 30-day mortality (relative risk 1.37, 95 % confidence interval [1.09, 1.73], P = 0.007), the COVID-19 negative group had higher long-term mortality. CONCLUSIONS Our findings suggest that while infection with COVID-19 has a significant effect on short-term outcomes after tracheostomy, chronic comorbidities seem to have the more enduring impact. In spite of prolonged ventilation and higher short-term mortality, tracheostomy in COVID-19 can be a positive intervention that does not necessarily predestine patients to the same level of long-term morbidity and mortality of typical tracheostomies.
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Affiliation(s)
- Suffia Alvi
- Jesse Brown VA Medical Center, Department of Veterans Affairs, Chicago, IL, United States of America; University of Illinois at Chicago College of Medicine, Chicago, IL, United States of America
| | - Thomas Blackwell
- Jesse Brown VA Medical Center, Department of Veterans Affairs, Chicago, IL, United States of America; University of Illinois at Chicago College of Medicine, Chicago, IL, United States of America
| | - Nicholas R Curran
- University of Cincinnati Medical Center, Cincinnati, OH, United States of America
| | - Arpita Germanwala
- Jesse Brown VA Medical Center, Department of Veterans Affairs, Chicago, IL, United States of America; University of Illinois at Chicago College of Medicine, Chicago, IL, United States of America.
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16
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Noy R, Shkedy Y, Simchon O, Gvozdev N, Roimi M, Miller A, Epstein D. Impact of radiological surveillance for major blood vessels on complications of percutaneous dilatational tracheostomy: A retrospective cohort study. Am J Otolaryngol 2024; 45:104146. [PMID: 38101131 DOI: 10.1016/j.amjoto.2023.104146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 12/03/2023] [Indexed: 12/17/2023]
Abstract
PURPOSE Percutaneous dilatational tracheostomy (PDT) is the preferred method for managing long-term ventilator-dependent patients in ICUs. This study aimed to evaluate the association between preprocedural screening (ultrasound Doppler [USD] or computed tomography [CT]) for major neck blood vessels and complications in ICU patients undergoing PDT. MATERIALS AND METHODS This was a retrospective cohort study of patients who underwent PDT between 2012 and 2023 at a tertiary referral center. We performed a multivariable analysis and created a propensity-matched cohort. The primary outcome was bleeding within the first seven days after PDT. Secondary outcomes included early and late PDT complications and PTD-related mortality. RESULTS A total of 1766 consecutive critically ill patients hospitalized at a tertiary academic hospital were evaluated for PDT. Of these, 881 (49.9 %) underwent only physical examination before PDT, while 885 (50.1 %) underwent additional imaging (CT/USD). A higher proportion of patients in the imaging group were referred to open surgery due to suspected major blood vessels interfering with the procedure (6.2 % vs. 3.0 %, p = 0.001). Among the 1685 patients who underwent PDT, there was no significant difference in the rate of early bleeding between the physical examination group and the imaging group (4.6 % vs. 6.3 %, p = 0.12). Similarly, the overall early complication rates (5.5 % vs. 7.6 %, p = 0.08), late complication rates (1.6 % vs. 2.2 %, p = 0.42), and PDT-related mortality rates (0.7 % vs. 0.6 %, p = 0.73) did not exhibit significant differences between the two groups. In a propensity score-matched cohort, results remained consistent. CONCLUSIONS Physical examination can effectively identify major neck blood vessels without increasing the risk of bleeding during and after PDT.
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Affiliation(s)
- Roee Noy
- Department of Otolaryngology-Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel.
| | - Yotam Shkedy
- Department of Otolaryngology-Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel; Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
| | - Omri Simchon
- Department of Anesthesiology, Rambam Health Care Campus, Haifa, Israel
| | - Natalia Gvozdev
- Department of Otolaryngology-Head and Neck Surgery, Rambam Health Care Campus, Haifa, Israel
| | - Michael Roimi
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Critical Care Division, Rambam Health Care Campus, Haifa, Israel
| | - Asaf Miller
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Medical Intensive Care Unit, Rambam Health Care Campus, Haifa, Israel
| | - Danny Epstein
- Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel; Critical Care Division, Rambam Health Care Campus, Haifa, Israel
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17
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Searl J, Genoa K, Fritz A, Kearney A, Pandian V, Brenner MJ, Doyle P. Perceptions and practices of people with a total laryngectomy during COVID-19 pandemic: A mixed methods analysis. Am J Otolaryngol 2024; 45:104126. [PMID: 38039911 PMCID: PMC10939873 DOI: 10.1016/j.amjoto.2023.104126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/19/2023] [Indexed: 12/03/2023]
Abstract
PURPOSE People with a total laryngectomy (PTL) confront safety threats related to altered airway anatomy and risk of adverse events is amplified during healthcare crises, as exemplified by COVID-19 pandemic. Understanding these challenges, how they are navigated by PTL, and what resources can be deployed to alleviate risk can improve interprofessional care by speech-language pathologists (SLPs), otolaryngologists, and other professionals. MATERIALS AND METHODS An online survey was disseminated to PTL in the United States during the COVID-19 pandemic, querying participants about safety concerns and sources of information accessed to address care. Descriptive statistics and Chi-square were used to analyze information sources consumed by tracheoesophageal, esophageal, and electrolaryngeal speakers. Content analysis was completed to identify themes and quantify responses by subtheme. RESULTS Among 173 respondent PTL, tracheoesophageal speakers preferentially sought otolaryngologist input, whereas esophageal and electrolaryngeal speakers more often chose SLPs (p < .01). Overall, tracheoesophageal speakers had more SLP or otolaryngologist contact. Many PTL reported stringent handwashing, neck cleaning, and hygienic risk mitigation strategies. Six themes emerged in content analysis involving risk of infection/transmission, heightened vigilance, changes to alaryngeal communication, modified tracheostoma coverage, diagnostic testing, and risk from comorbid conditions. Limited provider contact suggested pandemic barriers to healthcare access. CONCLUSIONS PTL have a range of laryngectomy-specific needs and concerns, and type of alaryngeal communication was associated with source of information sought. Collaborations among healthcare professionals need to be optimized to improve patient navigation and overall access to specialized care.
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Affiliation(s)
- Jeff Searl
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, MI, USA.
| | - Kathryn Genoa
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, MI, USA.
| | - Alyssa Fritz
- Department of Communicative Sciences and Disorders, Michigan State University, East Lansing, MI, USA.
| | - Ann Kearney
- Division of Laryngology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA.
| | - Vinciya Pandian
- Center for Immersive Learning and Digital Innovation, Johns Hopkins School of Nursing, Baltimore, MD, USA.; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, USA; Global Tracheostomy Collaborative, Raleigh, NC, USA.
| | - Michael J Brenner
- Department of Otolaryngology - Head and Neck Surgery, University of Michigan Medical School, Ann Arbor, MI, USA; Global Tracheostomy Collaborative, Raleigh, NC, USA.
| | - Philip Doyle
- Division of Laryngology, Department of Otolaryngology - Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA.
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18
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Foran PL, Benjamin WJ, Sperry ED, Best SR, Boisen SE, Bosworth B, Brodsky MB, Shaye D, Brenner MJ, Pandian V. Tracheostomy-related durable medical equipment: Insurance coverage, gaps, and barriers. Am J Otolaryngol 2024; 45:104179. [PMID: 38118384 PMCID: PMC10939813 DOI: 10.1016/j.amjoto.2023.104179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 12/05/2023] [Indexed: 12/22/2023]
Abstract
PURPOSE Tracheostomy care is supply- and resource-intensive, and airway-related adverse events in community settings have high rates of readmission and mortality. Devices are often implicated in harm, but little is known about insurance coverage, gaps, and barriers to obtaining tracheostomy-related medically necessary durable medical equipment. We aimed to identify barriers patients may encounter in procuring tracheostomy-related durable medical equipment through insurance plan coverage. MATERIALS AND METHODS Tracheostomy-related durable medical equipment provisions were evaluated across insurers, extracting data via structured telephone interviews and web-based searches. Each insurance company was contacted four times and queried iteratively regarding the range of coverage and co-pay policies. Outcome measures include call duration, consistency of explanation of benefits, and the number of transfers and disconnects. We also identified six qualitative themes from patient interviews. RESULTS Tracheostomy-related durable medical equipment coverage was offered in some form by 98.1 % (53/54) of plans across 11 insurers studied. Co-pays or deductibles were required in 42.6 % (23/54). There was significant variability in out-of-pocket expenditures. Fixed co-pays ranged from $0-30, and floating co-pays ranged from 0 to 40 %. During phone interviews, mean call duration was 19 ± 10 min, with an average of 2 ± 1 transfers between agents. Repeated calls revealed high information variability (mean score 2.4 ± 1.5). Insurance sites proved challenging to navigate, scoring poorly on usability, literacy, and information quality. CONCLUSIONS Several factors may limit access to potentially life-saving durable medical equipment for patients with tracheostomy. Barriers include out-of-pocket expenditures, lack of transparency on coverage, and low-quality information. Further research is necessary to evaluate patient outcomes.
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Affiliation(s)
- Palmer L Foran
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University, Baltimore, MD, United States
| | | | | | - Simon R Best
- Department of Otolaryngology-Head & Neck Surgery, Johns Hopkins University, Baltimore, MD, United States
| | - Sarah E Boisen
- Pediatric Intensive Care Unit, Seattle Children's Hospital, Seattle, WA, United States
| | | | - Martin B Brodsky
- Head and Neck Institute, Cleveland Clinic, Cleveland, OH; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, United States; Department of Physical and Rehabilitation, Johns Hopkins University, Baltimore, MD, United States
| | - David Shaye
- Department of Otolaryngology-Head & Neck Surgery, Harvard Medical School Massachusetts Eye and Ear, United States
| | - Michael J Brenner
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan, Ann Arbor, MI, United States; Global Tracheostomy Collaborative, Raleigh, NC, United States; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States
| | - Vinciya Pandian
- Center for Immersive Learning and Digital Innovation Johns Hopkins University School of Nursing, Baltimore, MD, United States; Global Tracheostomy Collaborative, Raleigh, NC, United States; Outcomes After Critical Illness and Surgery (OACIS) Research Group, Johns Hopkins University, Baltimore, MD, United States; Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, MD, United States.
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19
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Sánchez-Gómez S, Molina-Fernández E, Acosta Mosquera ME, Palacios-García JM, López-Álvarez F, Juana Morrondo MSD, Tena-García B. Tracheotomy versus tracheostomy, the need for lexicographical clarification. Acta Otorrinolaringol Esp (Engl Ed) 2024; 75:73-82. [PMID: 38224867 DOI: 10.1016/j.otoeng.2023.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 06/25/2023] [Indexed: 01/17/2024]
Abstract
In the healthcare field, the terms "traqueotomía" and "traqueostomía" are frequently used, often leading to confusion among professionals regarding the appropriate definition for each term or which one should be considered more correct in specific cases. A search was conducted for the terms "traqueotomía" and "traqueostomía" in general Spanish-language dictionaries such as the Dictionary of the Royal Spanish Academy (DRAE) and the Historical Dictionary of the Spanish Language of the Royal Spanish Academy (DHLE), as well as for the English terms "tracheotomy" and "tracheostomy" in English general dictionaries like the Oxford Dictionary, the Cambridge Dictionary, and the Collins English Dictionary. Additionally, searches were performed in medical dictionaries in both Spanish, specifically the Dictionary of Medical Terms of the National Academy of Medicine (DTM), and English, including the Farlex Dictionary. The terms were also explored using the Google search engine. Definitions were analyzed from both lexicographical and etymological perspectives. Definitions found in general dictionaries, in both Spanish and English, were found to be imprecise, limited, and ambiguous, as they mixed outdated indications with criteria that deviated from etymology. In contrast, definitions in medical dictionaries in both languages were more aligned with etymology. "Traqueotomía" strictly identifies the surgical procedure of creating an opening in the anterior face of the trachea. "Traqueostomía" identifies the creation of an opening that connects the trachea to the exterior, involving a modification of the upper airway by providing an additional entry for the respiratory pathway. "Traqueostomía" becomes the sole means of entry to the airway in total laryngectomies. Both terms can be used synonymously when a traqueotomía culminates in a traqueostomía. However, it is not appropriate to use the term "traqueostomía" when the procedure concludes with the closure of the planes and does not result in the creation of a stoma. Traqueostomas can be qualified with adjectives indicating permanence (temporary/permanent), size (large/small), shape (round/elliptical), or depth, without being linked to any specific disease or surgical indication. Not all permanent traqueostomas are the result of total laryngectomies, and they do not necessarily have an irreversible character systematically.
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Affiliation(s)
- Serafín Sánchez-Gómez
- Servicio de Otorrinolaringología, Hospital Universitario Virgen Macarena, Sevilla, Spain.
| | - Elena Molina-Fernández
- Servicio de Otorrinolaringología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | | | - Fernando López-Álvarez
- Servicio de Otorrinolaringología, Hospital Universitario Central de Asturias, Oviedo, Spain
| | | | - Beatriz Tena-García
- Servicio de Otorrinolaringología, Hospital Universitario Virgen Macarena, Sevilla, Spain
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20
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Xourgia E, Koronaios A, Kotanidou A, Siempos II, Routsi C. Right ventricular free wall longitudinal strain during weaning from mechanical ventilation using high-flow or conventional oxygen treatment: a pilot study. Ultrasound J 2024; 16:17. [PMID: 38411848 PMCID: PMC10899142 DOI: 10.1186/s13089-024-00358-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Accepted: 01/22/2024] [Indexed: 02/28/2024] Open
Affiliation(s)
- Eleni Xourgia
- First Department of Critical Care Medicine and Pulmonary Services, National and Kapodistrian University of Athens, Medical School Evangelismos Hospital, 45-47 Ipsilantou Street, 10676, Athens, Greece
- Department of Heart Surgery, Lnselspital, University Hospital, University of Bern, Bern, Switzerland
| | - Apostolos Koronaios
- First Department of Critical Care Medicine and Pulmonary Services, National and Kapodistrian University of Athens, Medical School Evangelismos Hospital, 45-47 Ipsilantou Street, 10676, Athens, Greece
| | - Anastasia Kotanidou
- First Department of Critical Care Medicine and Pulmonary Services, National and Kapodistrian University of Athens, Medical School Evangelismos Hospital, 45-47 Ipsilantou Street, 10676, Athens, Greece
| | - Ilias I Siempos
- First Department of Critical Care Medicine and Pulmonary Services, National and Kapodistrian University of Athens, Medical School Evangelismos Hospital, 45-47 Ipsilantou Street, 10676, Athens, Greece
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Christina Routsi
- First Department of Critical Care Medicine and Pulmonary Services, National and Kapodistrian University of Athens, Medical School Evangelismos Hospital, 45-47 Ipsilantou Street, 10676, Athens, Greece.
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21
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Jadhav R, Jadhav R. A cross-sectional study to evaluate the impact of early tracheostomy in management of neurosurgical patients. Ir J Med Sci 2024:10.1007/s11845-024-03636-2. [PMID: 38372946 DOI: 10.1007/s11845-024-03636-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/12/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Tracheostomy is a crucial procedure in the management of neurosurgical patients, and determining the appropriate timing for the intervention remains a contentious issue. While some experts advocate for early tracheostomy, others recommend a more conservative approach of closely monitoring the patient's condition before performing the procedure. METHODS To shed light on this debate, a retrospective observational cohort study was conducted on 78 cases who underwent tracheostomy in the neurosurgical ICU of Yashosai Hospital, Nanded, Maharashtra, between January and December 2022. The study relied on hospital records, and descriptive statistics were used to represent the quantitative data. RESULTS The study's findings showed that the majority of the study subjects were male, with an average age of 46.3 + / - 15.2 years. The results suggested that early tracheostomy was associated with improved outcomes in terms of shorter durations of tracheostomy, hospital stays, ICU stays, and mechanical ventilation. However, the incidence of complications did not differ significantly between the early and late tracheostomy groups. CONCLUSION Overall, this study provides valuable insights into the optimal management of neurosurgical patients, with implications for clinical practice and patient outcomes.
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Affiliation(s)
- Ruchita Jadhav
- Yashosai Hospital (Neurosurgical and Trauma Care Unit), Nanded-Waghala, India.
| | - Rupal Jadhav
- Yashosai Hospital (Neurosurgical and Trauma Care Unit), Nanded-Waghala, India
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22
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Gómez-Ríos MÁ, Sastre JA, Onrubia-Fuertes X, López T, Abad-Gurumeta A, Casans-Frances R, Gómez-Ríos D, Garzón JC, Martínez-Pons V, Casalderrey-Rivas M, Fernández-Vaquero MÁ, Martínez-Hurtado E, Martín-Larrauri R, Reviriego-Agudo L, Gutierrez-Couto U, García-Fernández J, Serrano-Moraza A, Rodríguez Martín LJ, Camacho Leis C, Espinosa Ramírez S, Fandiño Orgeira JM, Vázquez Lima MJ, Mayo-Yáñez M, Parente-Arias P, Sistiaga-Suárez JA, Bernal-Sprekelsen M, Charco-Mora P. Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR) Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Part II. Rev Esp Anestesiol Reanim (Engl Ed) 2024:S2341-1929(24)00022-2. [PMID: 38340790 DOI: 10.1016/j.redare.2024.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 08/28/2023] [Indexed: 02/12/2024]
Abstract
The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factor, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.
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Affiliation(s)
- M Á Gómez-Ríos
- Anesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
| | - J A Sastre
- Anesthesiology and Perioperative Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | - Teresa López
- Anesthesiology and Perioperative Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - A Abad-Gurumeta
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - R Casans-Frances
- Department of Anesthesiology, Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain
| | | | - J C Garzón
- Anesthesiology and Perioperative Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - V Martínez-Pons
- Department of Anesthesiology, Hospital Universitari i Politecnic La Fe, Valencia, Spain
| | - M Casalderrey-Rivas
- Department of Anesthesiology. Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - M Á Fernández-Vaquero
- Department of Anesthesiology, Hospital Clínica Universitaria de Navarra, Madrid, Spain
| | - E Martínez-Hurtado
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | | | - L Reviriego-Agudo
- Department of Anesthesiology, Hospital Clínico Universitario, Valencia, Spain
| | - U Gutierrez-Couto
- Biblioteca, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - J García-Fernández
- Department of Anesthesiology, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Spain; President of the Spanish Society of Anesthesiology, Resuscitation and Pain Therapy (SEDAR), Spain
| | | | | | | | | | - J M Fandiño Orgeira
- Servicio de Urgencias, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - M J Vázquez Lima
- Emergency Department, Hospital do Salnes, Vilagarcía de Arousa, Pontevedra, Spain; President of the Spanish Emergency Medicine Society (SEMES), Spain
| | - M Mayo-Yáñez
- Department of Otorhinolaryngology/Head Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - P Parente-Arias
- Department of Otorhinolaryngology/Head Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - J A Sistiaga-Suárez
- Department of Otorhinolaryngology, Hospital Universitario Donostia, Donostia, Gipuzkoa, Spain
| | - M Bernal-Sprekelsen
- Department of Otorhinolaryngology, Hospital Clinic Barcelona, Barcelona Spain; President of the Spanish Society for Otorhinolaryngology Head & Neck Surgery (SEORL-CCC)
| | - P Charco-Mora
- Department of Anesthesiology, Hospital Universitari i Politecnic La Fe, Valencia, Spain
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23
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Gómez-Ríos MÁ, Sastre JA, Onrubia-Fuertes X, López T, Abad-Gurumeta A, Casans-Frances R, Gómez-Ríos D, Garzón JC, Martínez-Pons V, Casalderrey-Rivas M, Fernández-Vaquero MÁ, Martínez-Hurtado E, Martín-Larrauri R, Reviriego-Agudo L, Gutierrez-Couto U, García-Fernández J, Serrano-Moraza A, Rodríguez Martín LJ, Camacho Leis C, Espinosa Ramírez S, Fandiño Orgeira JM, Vázquez Lima MJ, Mayo-Yáñez M, Parente-Arias P, Sistiaga-Suárez JA, Bernal-Sprekelsen M, Charco-Mora P. Spanish Society of Anesthesiology, Reanimation and Pain Therapy (SEDAR), Spanish Society of Emergency and Emergency Medicine (SEMES) and Spanish Society of Otolaryngology, Head and Neck Surgery (SEORL-CCC) Guideline for difficult airway management. Rev Esp Anestesiol Reanim (Engl Ed) 2024:S2341-1929(24)00021-0. [PMID: 38340791 DOI: 10.1016/j.redare.2024.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 08/28/2023] [Indexed: 02/12/2024]
Abstract
The Airway Management section of the Spanish Society of Anesthesiology, Resuscitation, and Pain Therapy (SEDAR), the Spanish Society of Emergency Medicine (SEMES), and the Spanish Society of Otorhinolaryngology and Head and Neck Surgery (SEORL-CCC) present the Guide for the comprehensive management of difficult airway in adult patients. Its principles are focused on the human factor, cognitive processes for decision-making in critical situations, and optimization in the progression of strategies application to preserve adequate alveolar oxygenation in order to enhance safety and the quality of care. The document provides evidence-based recommendations, theoretical-educational tools, and implementation tools, mainly cognitive aids, applicable to airway management in the fields of anesthesiology, critical care, emergencies, and prehospital medicine. For this purpose, an extensive literature search was conducted following PRISMA-R guidelines and was analyzed using the GRADE methodology. Recommendations were formulated according to the GRADE methodology. Recommendations for sections with low-quality evidence were based on expert opinion through consensus reached via a Delphi questionnaire.
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Affiliation(s)
- M Á Gómez-Ríos
- Anesthesiology and Perioperative Medicine, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
| | - J A Sastre
- Anesthesiology and Perioperative Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | - T López
- Anesthesiology and Perioperative Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - A Abad-Gurumeta
- Department of Anesthesiology, Hospital Universitario Infanta Leonor, Madrid, Spain
| | - R Casans-Frances
- Department of Anesthesiology, Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain
| | | | - J C Garzón
- Anesthesiology and Perioperative Medicine, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - V Martínez-Pons
- Department of Anesthesiology, Hospital Universitari i Poliècnic La Fe, Valencia, Spain
| | - M Casalderrey-Rivas
- Department of Anesthesiology, Complejo Hospitalario Universitario de Ourense, Ourense, Spain
| | - M Á Fernández-Vaquero
- Department of Anesthesiology, Hospital Clínica Universitaria de Navarra, Madrid, Spain
| | - E Martínez-Hurtado
- Department of Anesthesiology, Hospital Universitario Infanta Elena, Valdemoro, Madrid, Spain
| | | | - L Reviriego-Agudo
- Department of Anesthesiology, Hospital Clínico Universitario, Valencia, Spain
| | - U Gutierrez-Couto
- Biblioteca, Complejo Hospitalario Universitario de Ferrol (CHUF), Ferrol, A Coruña, Spain
| | - J García-Fernández
- Department of Anesthesiology, Hospital Universitario Puerta de Hierro-Majadahonda, Majadahonda, Madrid, Spain; Presidente de la Sociedad Española de Anestesiología, Reanimación y Terapéutica del Dolor (SEDAR)
| | | | | | - C Camacho Leis
- Servicio de Urgencias, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | | | - J M Fandiño Orgeira
- Servicio de Urgencias, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - M J Vázquez Lima
- Emergency Department, Hospital do Salnes, Vilagarcía de Arousa, Pontevedra, Spain; President of the Spanish Emergency Medicine Society (SEMES)
| | - M Mayo-Yáñez
- Department of Otorhinolaryngology - Head Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - P Parente-Arias
- Department of Otorhinolaryngology - Head Neck Surgery, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
| | - J A Sistiaga-Suárez
- Department of Otorhinolaryngology, Hospital Universitario Donostia, Donostia, Gipuzkoa, Spain
| | - M Bernal-Sprekelsen
- Department of Otorhinolaryngology, Hospital Clínic Barcelona, University of Barcelona, Barcelona, Spain; President of the Spanish Society for Otorhinolaryngology Head & Neck Surgery (SEORL-CCC)
| | - P Charco-Mora
- Department of Anesthesiology, Hospital Universitari i Poliècnic La Fe, Valencia, Spain
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24
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Likar R, Aroyo I, Bangert K, Degen B, Dziewas R, Galvan O, Grundschober MT, Köstenberger M, Muhle P, Schefold JC, Zuercher P. Management of swallowing disorders in ICU patients - A multinational expert opinion. J Crit Care 2024; 79:154447. [PMID: 37924574 DOI: 10.1016/j.jcrc.2023.154447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 09/19/2023] [Accepted: 10/10/2023] [Indexed: 11/06/2023]
Abstract
BACKGROUND Dysphagia is common in intensive care unit (ICU) patients, yet it remains underrecognized and often unmanaged despite being associated with life-threatening complications, prolonged ICU stays and hospitalization. PURPOSE To propose an expert opinion for the diagnosis and management of dysphagia developed from evidence-based clinical recommendations and practitioner insights. METHODS A multinational group of dysphagia and critical care experts conducted a literature review using a modified ACCORD methodology. Based on a fusion of the available evidence and the panel's clinical experience, an expert opinion on best practice management was developed. RESULTS The panel recommends adopting clinical algorithms intended to promote standardized, high-quality care that triggers timely systematic dysphagia screening, assessment, and treatment of extubated and tracheostomized patients in the ICU. CONCLUSIONS Given the lack of robust scientific evidence, two clinical management algorithms are proposed for use by multidisciplinary teams to improve early systematic detection and effective management of dysphagia in ICU patients. Additionally, emerging therapeutic options such as neurostimulation have the potential to improve the quality of ICU dysphagia care.
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Affiliation(s)
- Rudolf Likar
- Department for Anaesthesiology and Intensive Medicine, Klinikum Klagenfurt am Wörthersee, Austria
| | - Ilia Aroyo
- Department of Neurology and Neurointensive Care Medicine, Klinikum Darmstadt, Germany
| | - Katrin Bangert
- Clinic for Intensive Care Medicine, University Hospital Hamburg, Germany
| | - Björn Degen
- Clinic for Intensive Medicine, Dysphagia Centre, Vienna, Austria
| | - Rainer Dziewas
- Department of Neurology and Neurological Rehabilitation, Klinikum Osnabrück, Osnabrück, Germany
| | - Oliver Galvan
- Department for Hearing, Speech and Voice Disorders, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Markus Köstenberger
- Department for Anaesthesiology and Intensive Medicine, Klinikum Klagenfurt am Wörthersee, Austria; Department for Anaesthesiology and Intensive Care Medicine, Medical University Graz, Graz, Austria.
| | - Paul Muhle
- Department of Neurology with Institute of Translational Neurology, University Hospital Münster, Germany
| | - Joerg C Schefold
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
| | - Patrick Zuercher
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Switzerland
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25
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Hegde K, Chandrashekarappa S, Patel S, Shetty S, Prakash BG. The Nasal Microarchitecture: How Does Tracheostomy Affect it? Indian J Otolaryngol Head Neck Surg 2024; 76:842-845. [PMID: 38440435 PMCID: PMC10908945 DOI: 10.1007/s12070-023-04290-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 10/14/2023] [Indexed: 03/06/2024] Open
Abstract
This study aims to evaluate the histological changes in the nasal mucosa post Tracheostomy. A prospective observational study was done on 30 patients undergoing Tracheostomy after obtaining written informed consent from patients/legally accepted representatives. Prior to Tracheostomy, anterior rhinoscopy was done, and findings were noted; nasal mucosal biopsy was obtained from the inferior turbinate. The patients enrolled were followed up for four weeks, and in the patients still having Tracheostomy, repeat inferior turbinate biopsies were taken and compared. Statistically significant atrophy of lining epithelium was seen in 80% of the subjects, i.e., pseudostratified lining epithelium at Baseline with multilayered appearance changed to a single layer of flattened cells at follow-up. There was also a marked reduction in the number of seromucinous glands in the stroma at follow-up in 80% of the subjects. Additionally, fibrosis in the stroma was noted in 43.3% of subjects at follow-up. The results from this study indicate that Tracheostomy, likely as a result of nasal airflow deprivation, brings about significant changes in the microanatomy of the nasal airway. The extent of this causation and its implication in nasal pathology must be studied in larger populations with extended follow-up periods.
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Affiliation(s)
- Kiran Hegde
- Department of Otorhinolaryngology, JSS Medical College, Mysore, India
| | | | - Sapna Patel
- Department of Pathology, JSS Medical College, Mysore, India
| | - Sandeep Shetty
- Department of Otorhinolaryngology, JSS Medical College, Mysore, India
| | - B. G. Prakash
- Department of Otorhinolaryngology, JSS Medical College, Mysore, India
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26
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Castro-Codesal M, Ofosu DB, Mack C, Majaesic C, van Manen M. Parents' experiences of their children's medical journeys with tracheostomies: A Focus Group Study. Paediatr Child Health 2024; 29:36-42. [PMID: 38332972 PMCID: PMC10848122 DOI: 10.1093/pch/pxad042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Accepted: 06/13/2023] [Indexed: 02/10/2024] Open
Abstract
Objectives Children living with a tracheostomy have among the most complex medical care needs in Canada. The focus of this study was to gain a contemporary understanding of key aspects of these children's medical journeys. Methods We conducted a qualitative constructivist grounded theory study using semi-structured focus groups with parents whose children are living in the community with a tracheostomy. Parents were recruited from the Stollery Children's Hospital Tracheostomy Clinic, which serves a geographically wide and diverse population. Results Three focus groups were completed, including a total of 12 participants. Key themes leading up to tracheostomy related to contextual understanding, experiences of inclusion, and perceptions of proportionality. Parents discussed the preparedness for how a tracheostomy would affect their child, their own involvement in recovery, and the education needed for their child's medical care. Navigating hospital units related to inconsistencies in care, accommodations of families' needs, and confidence in care received. Finally, living in the community was the focus of much of the participants' discussions including coping with system-related issues, limited homecare and medical support, cost of care, and connections with the broader community of parents of children with complex medical needs. All themes encircled the family's deeply felt responsibility to care for their child. Conclusions From both patient- and family-centered care perspectives, there exist individual and systemic issues related to the care delivery for children with a tracheostomy. It is in particular in the community where there is a severe deficiency of support afforded to these children and their families.
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Affiliation(s)
| | | | - Cheryl Mack
- Department of Pediatrics, University of Alberta, Edmonton, Alberta
- Department of Anesthesiology and Pain Medicine, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta
| | - Carina Majaesic
- Department of Pediatrics, University of Alberta, Edmonton, Alberta
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Williams H, Bhatt A, Dzioba A, You P, Husein M, Paradis J, Strychowsky JE, Theurer J, Graham ME. Feeding outcomes in tracheostomy-dependent infants - can we predict future gastrostomy tube use? Int J Pediatr Otorhinolaryngol 2024; 177:111877. [PMID: 38295685 DOI: 10.1016/j.ijporl.2024.111877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/15/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVES To identify characteristics of infants with tracheostomy that require gastrostomy tube insertion versus those likely to orally feed to predict which patients may benefit from insertion of gastrostomy at the time of tracheostomy placement. METHODS Retrospective review of infants undergoing tracheostomy from birth to 18 months of age. The primary outcome was to identify pre-operative factors predictive of future gastrostomy tube use. Univariate and multivariate analyses evaluated association between pre-operative patient characteristics and feeding outcomes. RESULTS Of 103 patients identified, 73 met inclusion criteria. Upper airway anomaly was the indication for tracheostomy in 70.4 %. Gastrostomy tube was required in 52 patients (75.4 %), with 7 (13.5 %) placed concurrently with tracheostomy. Infants with birth complications, a neurologic diagnosis, multiple co-morbidities, or identified with aspiration risk were more likely to require a gastrostomy tube (p < 0.05). CONCLUSIONS Most infants who require tracheostomy placement from birth until 18 months of age will require nutritional support. Tracheostomy and gastrostomy are uncommonly placed concurrently. Coordination of placement would theoretically minimize the risk of general anesthetic exposure while potentially reducing hospital length of stay and healthcare related costs.
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Affiliation(s)
- Harley Williams
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Ayushi Bhatt
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Agnieszka Dzioba
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Department of Otolaryngology Head and Neck Surgery, London Health Sciences Centre, London, ON, Canada
| | - Peng You
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Department of Otolaryngology Head and Neck Surgery, London Health Sciences Centre, London, ON, Canada
| | - Murad Husein
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Department of Otolaryngology Head and Neck Surgery, London Health Sciences Centre, London, ON, Canada
| | - Josee Paradis
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Department of Otolaryngology Head and Neck Surgery, London Health Sciences Centre, London, ON, Canada
| | - Julie E Strychowsky
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Department of Otolaryngology Head and Neck Surgery, London Health Sciences Centre, London, ON, Canada
| | - Julie Theurer
- Department of Otolaryngology Head and Neck Surgery, London Health Sciences Centre, London, ON, Canada; School of Communication Sciences and Disorders, Western University, London, ON, Canada
| | - M Elise Graham
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada; Department of Otolaryngology Head and Neck Surgery, London Health Sciences Centre, London, ON, Canada.
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Kumar S, Biradar K, Patra A. Tracheostomy Complications: Insights from a Two-Year, 15-Case Analysis at a Tertiary Care Facility. Indian J Otolaryngol Head Neck Surg 2024; 76:1470-1475. [PMID: 38440471 PMCID: PMC10908678 DOI: 10.1007/s12070-023-04272-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 10/05/2023] [Indexed: 03/06/2024] Open
Abstract
The objective of this case series was to analyse the complications that arise from tracheostomy procedures conducted in a tertiary healthcare facility throughout a two-year timeframe. Fifteen occurrences of complications were observed out of the 100 tracheostomies that were studied, suggesting a prevalence rate of 15%. The detected complications included subcutaneous emphysema, misplacement of the tube, infection at the surgical site, and tracheal stenosis, among various others. Considerable indications of complication were identified, encompassing variables such as age and a history of head and neck cancer. The findings of this study highlight the significance of personalized patient care, vigilant monitoring, and proactive measures for individuals receiving tracheostomy. Further investigations are necessary to validate these findings and improve patient safety and outcomes in the realm of tracheostomy surgeries.
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Affiliation(s)
- Sanjay Kumar
- Department of ENT, Command Hospital Airforce Bangalore, Rajiv Gandhi University of Health Sciences, Bangalore, India
| | - Kashiroygoud Biradar
- Department of ENT, Command Hospital Airforce Bangalore, Rajiv Gandhi University of Health Sciences, Bangalore, India
| | - Arun Patra
- Department of Anaesthesia, Command Hospital Bangalore, Rajiv Gandhi University of Health Sciences, Bangalore, India
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MS V, Surendran AK, Raja K. Beyond the Norm: Tracheostomy's Vital Role in Unconventional Foreign Body Removal. Indian J Otolaryngol Head Neck Surg 2024; 76:1183-1186. [PMID: 38440569 PMCID: PMC10908883 DOI: 10.1007/s12070-023-04206-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Accepted: 08/31/2023] [Indexed: 03/06/2024] Open
Abstract
BACKGROUND Foreign Body Aspiration (FBA) is one of the paediatric emergencies which require timely diagnosis and management. The inherent tendency of children to explore small objects with their mouths often prove to be fatal as they are difficult to remove once aspirated. CASE REPORT We present the case of a 5-year-old boy who presented with dyspnea and vomiting following the aspiration of a pen cap. Chest radiograph and Rigid Bronchoscopy helped to identify the foreign body but it couldn't be removed by Rigid Bronchoscopy alone due it's wedge-shaped nature. Hence, an unconventional method of foreign body removal was performed by making a tracheostoma, pushing the foreign body to the level of tracheostoma and thereby taking it out from the tracheostoma under strict monitoring of anesthesia team. CONCLUSION Alternative approaches like this are required for prompt intervention in a difficult case as it helps to reduce complications produced by repeated failed attempts.
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Affiliation(s)
- Vishak MS
- Department of Otorhinolaryngology, JIPMER, Puducherry, India
| | | | - Kalaiarasi Raja
- Department of Otorhinolaryngology, JIPMER, Puducherry, India
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30
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Higashino M, Saito K, Tsukahara K, Hyodo M, Hirabayashi H, Kawata R. Tracheostomy in otorhinolaryngology education and training programs: A Japanese nationwide survey. Auris Nasus Larynx 2024; 51:69-75. [PMID: 37563043 DOI: 10.1016/j.anl.2023.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 08/12/2023]
Abstract
OBJECTIVE Surgical airway management is one of the most effective techniques for safe airway management. Within the training programs relating to knowledge and skills required by otorhinolaryngologists, tracheostomy and postoperative management are important items that must be fully understood by airway surgeons. We performed a nationwide survey to identify problems within tracheostomy and postoperative management in Japan in order to establish practical and safe guidelines for surgical airway management. METHODS We conducted a questionnaire survey of the current status of tracheostomy and postoperative management at core institution of otorhinolaryngology training programs in Japan. RESULTS Responses were obtained from all 101 core training institutions in Japan. Tracheostomy was performed in the operating room at 61.4% of institutions and in the ICU at 26.7%. 89.1% of them performed surgical tracheostomy (ST) in all cases. Even in the remaining 10.9%, percutaneous dilatational tracheostomy (PDT) was performed in less than 10% of cases. The primary surgeon was an otorhinolaryngology resident at 89.1% of institutions. The method of securing the tube immediately after surgery was by securing it with an attached cord at 48.5% of institutions, by suturing to the skin at 25.7%, and using a Velcro band at 24.8%. The first tube change after tracheostomy was performed on the seventh postoperative day at 81.2% of institutions. 87.1% had more than one person performing the first tube change. The tracheostomy postoperative complications within the past year were as follows: tracheostomal granulation: 89.1%; subcutaneous and/or mediastinal emphysema: 62.4%; tube stenosis: 55.4%; accidental tube removal: 50.5%; incorrect tube insertion or misplacement: 15.8%; hemorrhage from tracheal foramen requiring hemostasis in the operating room: 14.9%; pneumothorax: 4.0%; tracheo-innominate arterial fistula: 2.0%; and tracheoesophageal fistula: 1.0%. The method for educating otorhinolaryngology residents about tracheostomy was on-the-job training at 98.0% of institutions. CONCLUSIONS For airway management in otorhinolaryngology training programs, after learning the basics of ST, PDT should also be well understood. Furthermore, in order to create safe educational programs for intraoperative and postoperative management, it is necessary to train otorhinolaryngologists with accurate knowledge and skills, and to strengthen collaboration with multiple professions in their leadership roles as airway surgeons.
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Affiliation(s)
- Masaaki Higashino
- Department of Otorhinolaryngology Head and Neck Surgery, Osaka Medical and Pharmaceutical University, Japan.
| | - Koichiro Saito
- Department of Otorhinolaryngology Head and Neck Surgery, Kyorin University, Japan
| | - Kiyoaki Tsukahara
- Department of Otorhinolaryngology Head and Neck Surgery, Tokyo Medical University, Japan
| | - Masamitsu Hyodo
- Department of Otorhinolaryngology Head and Neck Surgery, Kochi University, Japan
| | - Hideki Hirabayashi
- Department of Otorhinolaryngology Head and Neck Surgery, Dokkyo Medical University, Japan
| | - Ryo Kawata
- Department of Otorhinolaryngology Head and Neck Surgery, Osaka Medical and Pharmaceutical University, Japan
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Robertson DJ, Jeziorczak PM, Aprahamian CJ. Diaphragmatic pacing for respiratory failure in children. Semin Pediatr Surg 2024; 33:151386. [PMID: 38245992 DOI: 10.1016/j.sempedsurg.2024.151386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Diaphragm pacing is a ventilation strategy in respiratory failure. Most of the literature on pacing involves adults with common indications being spinal cord injury and amyotrophic lateral sclerosis (ALS). Previous reports in pediatric patients consist of case reports or small series; most describe direct phrenic nerve stimulation for central hypoventilation syndrome. This differs from adult reports that focus most commonly on spinal cord injuries and the rehabilitative nature of diaphragm pacing. This review describes the current state of diaphragm pacing in pediatric patients. Indications, current available technologies, surgical techniques, advantages, and pitfalls/problems are discussed.
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Affiliation(s)
- Daniel J Robertson
- Division of Pediatric Surgery, Children's Hospital of Illinois, OSF Healthcare, Peoria, IL, United States; University of Illinois College of Medicine, Peoria, IL, United States.
| | - Paul M Jeziorczak
- Division of Pediatric Surgery, Children's Hospital of Illinois, OSF Healthcare, Peoria, IL, United States; University of Illinois College of Medicine, Peoria, IL, United States
| | - Charles J Aprahamian
- Division of Pediatric Surgery, Children's Hospital of Illinois, OSF Healthcare, Peoria, IL, United States; University of Illinois College of Medicine, Peoria, IL, United States
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Noy R, Habashi N, Akrish S, Cohen J, Shkedy Y. Preoperative tracheostomy is associated with thyroid gland invasion and poorer prognosis in laryngectomized patients. Eur Arch Otorhinolaryngol 2024; 281:935-943. [PMID: 37880425 DOI: 10.1007/s00405-023-08302-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 10/17/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE Patients with laryngeal cancer may necessitate tracheostomy placement to alleviate compromised airways. However, the impact of tracheostomy on thyroid gland invasion and its implications for prognosis in individuals who further undergo total laryngectomy remains unclear. This study aimed to assess thyroid gland invasion rates and explore the 5-years disease-free and overall survival in laryngectomized patients stratified by preoperative tracheostomy. METHODS All patients who underwent total laryngectomy for laryngeal cancer between 2003 and 2023 at a tertiary referral center were retrospectively reviewed. Logistic univariable and multivariable regressions were performed to identify factors associated with thyroid gland invasion. Survival analyses were performed using the Kaplan-Meier estimator. RESULTS A total of 119 laryngectomized patients were included (mean age: 63 ± 10 years, range 35-89, 110 [92.4%] males); 27 (22.7%) underwent preoperative tracheostomy. In 16 (13.4%) patients, tumor cells were found within the thyroid gland. In a multivariable analysis, thyroid gland invasion was independently associated with preoperative tracheostomy (odds ratio [OR] 3.13, 95% confidence interval [CI] 2.45-6.19), pN2 + (OR 2.13, 95% CI 1.8-5.14), positive margins (OR 1.36, 95% CI 1.01-1.77), lower 5-year disease-free survival (38% vs. 57%, p = 0.01), and lower 5-year overall survival (40% vs. 56%, p = 0.03). CONCLUSION Preoperative tracheostomy is an independent predictive factor for thyroid gland invasion and has adverse oncological outcomes in laryngectomized patients. Conversely, the rates of thyroid gland invasion are low when tracheostomy was not performed beforehand.
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Affiliation(s)
- Roee Noy
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, 8 Ha'Aliya Street, 3109601, Haifa, Israel.
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
| | - Nadeem Habashi
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, 8 Ha'Aliya Street, 3109601, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Sharon Akrish
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
- Department of Pathology, Rambam Health Care Campus, Haifa, Israel
| | - Jacob Cohen
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, 8 Ha'Aliya Street, 3109601, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Yotam Shkedy
- Department of Otolaryngology - Head and Neck Surgery, Rambam Health Care Campus, 8 Ha'Aliya Street, 3109601, Haifa, Israel
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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Mäkitie RE, Nyman K, Ilmarinen T, Tapiovaara L. Changes in occurrence and management of laryngeal fractures at the Helsinki University Hospital during 25 years. Eur Arch Otorhinolaryngol 2024; 281:915-924. [PMID: 37923860 PMCID: PMC10796824 DOI: 10.1007/s00405-023-08298-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 10/17/2023] [Indexed: 11/06/2023]
Abstract
PURPOSE Laryngeal fracture is a rare but potentially life-threatening trauma. Fractures vary from mild to dislocated and extensive with risk of severe complications. This study investigated the occurrence, clinical characteristics and management of laryngeal fractures in the last 15 years. MATERIAL AND METHODS A retrospective population-based cohort study reviewing all laryngeal fractures at the Helsinki University Hospital in 2005-2019. Patient records and imaging studies were systematically reviewed for mode of injury, fracture type, secondary complications, treatment modality, possible airway management, length of stay, and mortality. Results were compared with corresponding data from 1995 to 2004. RESULTS Overall 80 fracture patients were recorded (5.3/year); 79% were men and mean age was 42 years (range 18-78). Altogether 91% were closed and 9% open. While unintentional traumas were most common (54%), an increasing proportion were from intentional injury (10%) or Schaefer Gr IV in severity (35%). Altogether 46% had compromised airway and 21% needed airway intervention; airway narrowing was more common with cricoid (p = 0.042) and multiple fractures (p = 0.07) and correlated positively with amount of dislocation (p = 0.001) and number of fracture lines (p = 0.006). Surgery was performed for 33%, of which 46% were Schaefer Gr IV and 62% from intentional trauma. Mortality was 1.4%. CONCLUSIONS Deliberate and violence-related laryngeal fractures have increased. These often result in more extensive injuries predisposing to compromised airway and requiring surgical intervention and longer treatment. Most fractures are still treated conservatively with good long-term outcomes. An observation period of 24 h is recommended to detect any delayed complications. Mortality remains low.
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Affiliation(s)
- Riikka E Mäkitie
- Department of Otorhinolaryngology-Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, FI-00029, Helsinki, Finland.
- Clinicum, Faculty of Medicine, University of Helsinki, Helsinki, Finland.
| | - Kristofer Nyman
- Radiology, HUS Diagnostic Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Taru Ilmarinen
- Department of Otorhinolaryngology-Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, FI-00029, Helsinki, Finland
| | - Laura Tapiovaara
- Department of Otorhinolaryngology-Head and Neck Surgery, Head and Neck Center, Helsinki University Hospital and University of Helsinki, Kasarmikatu 11-13, FI-00029, Helsinki, Finland
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Schneider H, Meis J, Klose C, Ratzka P, Niesen WD, Seder DB, Bösel J. Surgical Versus Dilational Tracheostomy in Patients with Severe Stroke: A SETPOINT2 Post hoc Analysis. Neurocrit Care 2024:10.1007/s12028-023-01933-9. [PMID: 38291277 DOI: 10.1007/s12028-023-01933-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 12/21/2023] [Indexed: 02/01/2024]
Abstract
BACKGROUND Tracheostomy in mechanically ventilated patients with severe stroke can be performed surgically or dilationally. Prospective data comparing both methods in patients with stroke are scarce. The randomized Stroke-Related Early Tracheostomy vs Prolonged Orotracheal Intubation in Neurocritical Care Trial2 (SETPOINT2) assigned 382 mechanically ventilated patients with stroke to early tracheostomy versus extubation or standard tracheostomy. Surgical tracheostomy (ST) was performed in 41 of 307 SETPOINT2 patients, and the majority received dilational tracheostomy (DT). We aimed to compare ST and DT in these patients with patients. METHODS All SETPOINT2 patients with ST were compared with a control group of patients with stroke undergoing DT (1:2), selected by propensity score matching that included the factors stroke type, SETPOINT2 randomization group, Stroke Early Tracheostomy score, patient age, and premorbid functional status. Successful decannulation was the primary outcome, and secondary outcome parameters included functional outcome at 6 months and adverse events attributable to tracheostomy. Potential predictors of decannulation were evaluated by regression analysis. RESULTS Baseline characteristics were comparable in the two groups of patients with stroke undergoing ST (n = 41) and matched patients with stroke undergoing DT (n = 82). Tracheostomy was performed significantly later in the ST group than in the DT group (median 9 [interquartile range {IQR} 5-12] vs. 9 [IQR 4-11] days after intubation, p = 0.025). Patients with ST were mechanically ventilated longer (median 19 [IQR 17-24] vs.14 [IQR 11-19] days, p = 0.008) and stayed in the intensive care unit longer (median 23 [IQR 16-27] vs. 17 [IQR 13-24] days, p = 0.047), compared with patients with DT. The intrahospital infection rate was significantly higher in the ST group compared to the DT group (14.6% vs. 1.2%, p = 0.002). At 6 months, decannulation rates (56% vs. 61%), functional outcomes, and mortality were not different. However, decannulation was performed later in the ST group compared to the DT group (median 81 [IQR 66-149] vs. 58 [IQR 32-77] days, p = 0.004). Higher baseline Stroke Early Tracheostomy score negatively predicted decannulation. CONCLUSIONS In ventilated patients with severe stroke in need of tracheostomy, surgical and dilational methods are associated with comparable decannulation rate and functional outcome at 6 months. However, ST was associated with longer time to decannulation and higher rates of early infections, supporting the dilational approach to tracheostomy in ventilated patients with stroke.
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Affiliation(s)
- Hauke Schneider
- Department of Neurology, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany.
- Medical Faculty, University of Dresden, Dresden, Germany.
| | - Jan Meis
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Christina Klose
- Institute of Medical Biometry, University of Heidelberg, Heidelberg, Germany
| | - Peter Ratzka
- Department of Neurology, University Hospital Augsburg, Stenglinstr. 2, 86156, Augsburg, Germany
| | - Wolf-Dirk Niesen
- Department of Neurology and Neurophysiology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - David B Seder
- Department of Critical Care Services, Maine Medical Center, Portland, ME, USA
| | - Julian Bösel
- University of Heidelberg, Heidelberg, Germany
- Johns Hopkins University Hospital, Baltimore, MD, USA
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Zhao J, Zheng W, Xuan NX, Zhou QC, Wu WB, Cui W, Tian BP. The impact of delayed tracheostomy on critically ill patients receiving mechanical ventilation: a retrospective cohort study in a chinese tertiary hospital. BMC Anesthesiol 2024; 24:39. [PMID: 38262946 PMCID: PMC10804499 DOI: 10.1186/s12871-024-02411-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 01/10/2024] [Indexed: 01/25/2024] Open
Abstract
OBJECTIVES The timing of tracheostomy for critically ill patients on mechanical ventilation (MV) is a topic of controversy. Our objective was to determine the most suitable timing for tracheostomy in patients undergoing MV. DESIGN Retrospective cohort study. SETTING AND PARTICIPANTS One thousand eight hundred eighty-four hospitalisations received tracheostomy from January 2011 to December 2020 in a Chinese tertiary hospital. METHODS Tracheostomy timing was divided into three groups: early tracheostomy (ET), intermediate tracheostomy (IMT), and late tracheostomy (LT), based on the duration from tracheal intubation to tracheostomy. We established two criteria to classify the timing of tracheostomy for data analysis: Criteria I (ET ≤ 5 days, 5 days < IMT ≤ 10 days, LT > 10 days) and Criteria II (ET ≤ 7 days, 7 days < IMT ≤ 14 days, LT > 14 days). Parameters such as length of ICU stay, length of hospital stay, and duration of MV were used to evaluate outcomes. Additionally, the outcomes were categorized as good prognosis, poor prognosis, and death based on the manner of hospital discharge. Student's t-test, analysis of variance (ANOVA), Mann-Whitney U test, Kruskal-Wallis test, Chi-square test, and Fisher's exact test were employed as appropriate to assess differences in demographic data and individual characteristics among the ET, IMT, and LT groups. Univariate Cox regression model and multivariable Cox proportional hazards regression model were utilized to determine whether delaying tracheostomy would increase the risk of death. RESULTS In both of two criterion, patients with delayed tracheostomies had longer hospital stays (p < 0.001), ICU stays (p < 0.001), total time receiving MV (p < 0.001), time receiving MV before tracheostomy (p < 0.001), time receiving MV after tracheostomy (p < 0.001), and sedation durations. Similar results were also found in sub-population diagnosed as trauma, neurogenic or digestive disorders. Multinomial Logistic regression identified LT was independently associated with poor prognosis, whereas ET conferred no clinical benefits compared with IMT. CONCLUSIONS In a mixed ICU population, delayed tracheostomy prolonged ICU and hospital stays, sedation durations, and time receiving MV. Multinomial logistic regression analysis identified delayed tracheostomies as independently correlated with worse outcomes. TRIAL REGISTRATION ChiCTR2100043905. Registered 05 March 2021. http://www.chictr.org.cn/listbycreater.aspx.
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Affiliation(s)
- Jie Zhao
- Department of Critical Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Rd, Hangzhou, 310009, China
- Department of Critical Care Medicine, The First Affiliated Hospital, Ningbo University, Ningbo, Zhejiang, China
| | - Wei Zheng
- Department of Critical Care Medicine, Zhejiang Daishan First People's Hospital, The Second Affiliated Hospital Daishan Branch, Zhejiang University School of Medicine, Zhoushan, China
| | - Nan-Xian Xuan
- Department of Critical Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Rd, Hangzhou, 310009, China
| | - Qi-Chao Zhou
- Department of Critical Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Rd, Hangzhou, 310009, China
| | - Wei-Bing Wu
- Department of Critical Care Medicine, Zhejiang Qingyuan People's Hospital, The Second Affiliated Hospital Qingyuan Branch, Zhejiang University School of Medicine, Lishui, China
| | - Wei Cui
- Department of Critical Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Rd, Hangzhou, 310009, China
| | - Bao-Ping Tian
- Department of Critical Care Medicine, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Rd, Hangzhou, 310009, China.
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Epperson MV, Mahajan A, Sethia R, Seim N, VanKoevering K, Morrison RJ. A deployable curriculum with 3D printed skills trainers for altered airway management. BMC Med Educ 2024; 24:39. [PMID: 38191417 PMCID: PMC10773045 DOI: 10.1186/s12909-023-05013-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/26/2023] [Accepted: 12/26/2023] [Indexed: 01/10/2024]
Abstract
BACKGROUND Altered Airway Anatomy (AAA), including tracheostomies and laryngectomies, may represent an area of unease for non-Otolaryngology trainees, due to a lack of exposure, structured education, or dedicated training in altered airway management. Inability to effectively stabilize an altered airway is associated with significant risk of patient morbidity and mortality. This study aims to assess the efficacy of a concise curriculum using three-dimensional (3D) printed airway models for skill training in improving Anesthesiology trainees' competency in AAA management. METHODS A prospective cohort of 42 anesthesiology residents at a tertiary care institution were guided through a 75-min curriculum on AAA, including case discussion, surgical video, and hands-on practice with tracheostomy and laryngectomy skills trainers. Pre- and post- course surveys assessing provider confidence (Likert scale) and knowledge (multiple choice questions) were administered. Additionally, an observed skills competency assessment was performed. RESULTS Self-perceived confidence improved from a summative score across all domains of 23.65/40 pre-course to 36.39/40 post-course (n = 31, p < 0.001). Technical knowledge on multiple choice questions improved from 71 to 95% (n = 29, p < 0.001). In the completed skills competency assessment, 42/42 residents completed 5/5 assessed tasks successfully, demonstrating objective skills-based competency. CONCLUSIONS This study demonstrates an improvement in anesthesiology resident self-assessed confidence, objective knowledge, and skills based competency surrounding management of patients with AAA following a 75-min simulation-based curriculum.
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Affiliation(s)
- Madison V Epperson
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-4241, USA.
| | - Arushi Mahajan
- University of Michigan Medical School, Ann Arbor, MI, USA
| | - Rishabh Sethia
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University, Columbus, OH, USA
| | - Nolan Seim
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University, Columbus, OH, USA
| | - Kyle VanKoevering
- Department of Otolaryngology-Head & Neck Surgery, The Ohio State University, Columbus, OH, USA
| | - Robert J Morrison
- Department of Otolaryngology-Head & Neck Surgery, University of Michigan, 1500 E. Medical Center Drive, Ann Arbor, MI, 48109-4241, USA
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Niziol R, Cooper A, Jacovou E, Christodoulides G, Alibhai M, Fry A. A rapid recovery protocol for head and neck oncology patients undergoing resection, free flap reconstruction, and tracheostomy: a feasibility study. Int J Oral Maxillofac Surg 2024:S0901-5027(23)00912-8. [PMID: 38176999 DOI: 10.1016/j.ijom.2023.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 11/01/2023] [Accepted: 11/10/2023] [Indexed: 01/06/2024]
Abstract
Enhanced recovery after surgery (ERAS) for head and neck oncology patients was first introduced in 2017 and was found to improve patient outcomes, in line with results from other surgical specialties. This article presents a rapid recovery protocol (RRP) to further enhance perioperative care in conjunction with the ERAS protocol, for patients undergoing ablative surgery together with free flap reconstruction and tracheostomy. A prospective multidisciplinary approach was adopted to identify a specific cohort of patients who would benefit from the RRP. Of 26 patients who fulfilled the eligibility criteria, 16 completed the RRP. On average, these patients spent 5 days less with a tracheostomy and were discharged 7 days sooner when compared to a matched control group of nine patients on the standard postoperative care pathway. This resulted in an approximate monetary saving of £ 9955 per patient for the hospital trust. These results demonstrate that the feasibility study should be rolled out further, as the RRP not only decreased the length of stay but also provided substantial monetary savings without compromising patient outcomes.
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Affiliation(s)
- R Niziol
- Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
| | - A Cooper
- Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - E Jacovou
- Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - G Christodoulides
- Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - M Alibhai
- Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - A Fry
- Guy's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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Kawar L, Clark E, Kubba H. External peri-stomal skin granulations in paediatric tracheostomy: Incidence, outcomes and a proposed treatment algorithm. Int J Pediatr Otorhinolaryngol 2024; 176:111821. [PMID: 38147731 DOI: 10.1016/j.ijporl.2023.111821] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 11/15/2023] [Accepted: 12/04/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND External peri-stomal skin granulations after tracheostomy in children are common and may interfere with routine tube changes. This study is the first attempt to describe the incidence and outcomes, along with a proposed treatment algorithm. METHODS A retrospective review of all inpatient children with a tracheostomy between January 2020 and May 2022 at the Royal Hospital for Children (RHC) in Glasgow. The presence of external peri-stomal granulation, date of onset and resolution, recurrence and treatment modalities were noted. All tracheostomy tubes used during the study period were made of silicone. RESULTS A total of 50 episodes of peri-stomal granulation were identified in 27 children (52 %). Median age at the end of the study period was 4.3 years, with younger children experiencing more frequent granulation. 3 episodes interfered with tracheostomy tube changes. Time to resolution of the granulation was significantly longer with topical steroid/antimicrobial ointment monotherapy, but recurrence was less common when this was used a first treatment modality. CONCLUSION Non-invasive measures such as topical anti-microbials should be used in the first instance when managing external stoma-site granulations. More invasive measures, such as silver nitrate cautery and surgical excision, should be considered if the granulation tissue is not improving or when it poses a risk to safe tube changes.
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Affiliation(s)
- Luai Kawar
- University College Hospital, 235 Euston Road, London NW1 2BU, England, UK.
| | - Emma Clark
- Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, Scotland, UK.
| | - Haytham Kubba
- Department of Paediatric Otolaryngology, Royal Hospital for Children, 1345 Govan Road, Glasgow, G51 4TF, Scotland, UK.
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Maeda H, Tomomatsu I, Iikura I, Ikari M, Kondo Y, Yamamoto M, Tamura M. The care burden for technology-dependent children with long-term home ventilation increases along with the improvement of their motor functions. Eur J Pediatr 2024; 183:135-147. [PMID: 37843613 PMCID: PMC10858118 DOI: 10.1007/s00431-023-05249-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2023] [Revised: 09/28/2023] [Accepted: 09/29/2023] [Indexed: 10/17/2023]
Abstract
Since the establishment of Japan's publicly supported pediatric home medical care (PHMC) system in 2012, the number of technology-dependent children (TDC) who are supported by PHMC has been increasing. We expected care to become easier as TDC mobility increased. However, many family caregivers complained of the opposite, that the burden of care increased as TDC's mobility increased. Therefore, we aimed to study the problems of the care burden of families in relation to the improvement of mobility of TDC with a focus on respiratory support. We conducted a survey among caregivers of TDC in two parts: a first survey was done between 2018 and 2020, and a follow-up survey in 2023. In each medical procedure, the correlation of TDC's motor function level with care burden was analyzed by using correlation analysis. In 15 households, caregivers' activities were monitored to elucidate the problems of the care objectively. The second survey was conducted in February 2023 in TDC whose medical records were available. Analysis of 418 cases showed that care-burden increased with improvements in the children's motor ability in tracheostomy, or remained the same in other procedures. A follow-up study in 262/418 cases of this group showed that part of these TDC with high mobility aged 1-8, after passing through the mobile phase with increased burden of care, had a high potential to be weaned from medical devices. Conclusion: For TDC who acquire motor skills during PHMC, the burden of care for caregivers either increases or remains the same. It is important to maintain social support for TDC on the recovering mobile stage. What is Known: • There was no clear information on the care burden when TDC become mobile. What is New: • We did a qualitative study to show that the care burden increases when TDC become mobile. • In addition, mobike TDC showed a high potential for recovery.
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Affiliation(s)
- Hirotoshi Maeda
- Medical Incorporated Foundation Harutaka Kai, Ueno Tosei Bldg. 9F, Higashi-Ueno 4-23-7, Taito-ku, Tokyo, 110-0015, Japan.
| | - Ikuko Tomomatsu
- TOMO Lab LLC, Shibuya-ku, Tokyo, Japan
- Graduate School of Human Sciences, Osaka University, Suita-city, Osaka, Japan
| | - Izumi Iikura
- Medical Incorporated Foundation Harutaka Kai, Ueno Tosei Bldg. 9F, Higashi-Ueno 4-23-7, Taito-ku, Tokyo, 110-0015, Japan
| | - Masahiro Ikari
- Medical Incorporated Foundation Harutaka Kai, Ueno Tosei Bldg. 9F, Higashi-Ueno 4-23-7, Taito-ku, Tokyo, 110-0015, Japan
| | - Youichi Kondo
- Medical Incorporated Foundation Harutaka Kai, Ueno Tosei Bldg. 9F, Higashi-Ueno 4-23-7, Taito-ku, Tokyo, 110-0015, Japan
| | - Miyuki Yamamoto
- Medical Incorporated Foundation Harutaka Kai, Ueno Tosei Bldg. 9F, Higashi-Ueno 4-23-7, Taito-ku, Tokyo, 110-0015, Japan
- Institude of Human Sciences, University of Tsukuba, Tsukuba-city, Ibaraki, Japan
| | - Masanori Tamura
- Faculty of Medicine, Saitama Medical University, Saitama-city, Saitama, Japan
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López-Hernández JC, Vargas-Cañas ES, Galnares-Olalde JA, López-Alderete JA, López-Pizano A, Rivas-Cruz MA, Violante-Villanueva JA, Paredes-Aragón E. Factors Predicting Prolonged Mechanical Ventilation in Guillain-Barré Syndrome. Can J Neurol Sci 2024; 51:98-103. [PMID: 36788667 DOI: 10.1017/cjn.2023.23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
BACKGROUND Up to 30% of patients with Guillain-Barré syndrome require mechanical ventilation and 5% die due to acute complications of mechanical ventilation. There is a considerable group of patients that will need prolonged mechanical ventilation (considered as >14 days) and should be considered for early tracheostomy. The objective of this study is to identify risk factors for prolonged mechanical ventilation. METHODS We prospectively analyzed patients with Guillain-Barré diagnosis with versus without prolonged mechanical ventilation. We considered clinical and electrophysiological characteristics and analyzed factors associated with prolonged mechanical ventilation. RESULTS Three hundred and three patients were included; 29% required mechanical ventilation. When comparing the groups, patients with prolonged invasive mechanical ventilation (IMV) have a lower score on the Medical Research Council score (19.5 ± 16.2 vs 27.4 ± 17.5, p = 0.03) and a higher frequency of dysautonomia (42.3% vs 19.4%, p = 0.037), as well as lower amplitudes of the distal compound muscle action potential (CMAP) of the median nerve [0.37 (RIQ 0.07-2.25) vs. 3.9 (RIQ1.2-6.4), p = <0.001] and ulnar nerve [0.37 (RIQ0.0-3.72) vs 1.5 (RIQ0.3-6.6), p = <0.001], and higher frequency of severe axonal damage in these nerves (distal CMAP ≤ 1.0 mV). Through binary logistic regression, severe axonal degeneration of the median nerve is an independent risk factor for prolonged IMV OR 4.9 (95%CI 1.1-21.5) p = 0.03, AUC of 0.774, (95%CI 0.66-0.88), p = < 0.001. CONCLUSIONS Severe median nerve damage is an independent risk factor for prolonged mechanical ventilation.
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Affiliation(s)
- Juan Carlos López-Hernández
- Neuromuscular Diseases Department, Instituto Nacional de Neurología y Neurocirugía, Mexico
- Neurologic Emergencies Department, Instituto Nacional de Neurología y Neurocirugía, Mexico
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Miu K, Magill J, Wyatt M, Hewitt R, Butler C, Cooke J. Revisiting the Great Ormond Street Hospital protocol for ward decannulation of children with tracheostomy. Int J Pediatr Otorhinolaryngol 2024; 176:111787. [PMID: 37988917 DOI: 10.1016/j.ijporl.2023.111787] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2023] [Revised: 11/02/2023] [Accepted: 11/12/2023] [Indexed: 11/23/2023]
Abstract
INTRODUCTION Tracheostomy decannulation is an important and final step in managing patients once the underlying issue requiring a tracheostomy resolves. However, no consensus exists on the optimal method to decannulate a paediatric patient. We revisit the Great Ormond Street Hospital (GOSH) tracheostomy decannulation protocol, a 5-day process involving downsizing the tracheostomy tube, capping, and observation, to evaluate its effectiveness and assess if changes to the protocol are required. METHOD This is a retrospective study, reviewing patient records between April 2018 and April 2023 from a single quaternary care centre. Data extracted include comorbidities, age at the time of decannulation, duration of tracheostomy, reason for tracheostomy insertion, whether a decannulation attempt was successful or not, and the timings of decannulation failure. RESULTS 66 patients that met the selection criteria underwent a decannulation trial between April 2018 and April 2023. 32 patients were male, and 34 patients were female. Age at attempted decannulations ranged from 1 year to 18 years, with an average age of 6.1 years. There were a total of 93 attempts at decannulation, with 51 (54.8%) successful attempts, 35 (56.5%) first decannulation attempt successes, and 42 (45.2%) unsuccessful attempts. 17 patients had 2 attempts at decannulation, and 4 patients had 3 or more attempts at decannulation. Of the unsuccessful attempts, patients mostly failed on capping of the tracheostomy tube with 33 failures (35.5%). CONCLUSION The GOSH protocol achieved similar success rates to comparable protocols. The protocol's multi-step approach provides thorough evaluation and support for patients during the decannulation process, and its success on a complex patient cohort supports its continued use.
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Affiliation(s)
- Kelvin Miu
- Department of Otorhinolaryngology, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, United Kingdom.
| | - Jennifer Magill
- Department of Otorhinolaryngology, The Royal London Hospital, Whitechapel Road, London, E1 1FR, United Kingdom.
| | - Michelle Wyatt
- Department of Otorhinolaryngology, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, United Kingdom.
| | - Richard Hewitt
- Department of Otorhinolaryngology, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, United Kingdom.
| | - Colin Butler
- Department of Otorhinolaryngology, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, United Kingdom.
| | - Joanne Cooke
- Department of Otorhinolaryngology, Great Ormond Street Hospital, Great Ormond Street, London, WC1N 3JH, United Kingdom.
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Kushihashi Y, Masubuchi T, Okamoto I, Fushimi C, Yamazaki M, Asano H, Aoki R, Fujii S, Asako Y, Tada Y. A Case of Photoimmunotherapy for Nasopharyngeal Carcinoma Requiring Emergency Tracheostomy. Case Rep Oncol 2024; 17:471-476. [PMID: 38500712 PMCID: PMC10948172 DOI: 10.1159/000537898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/13/2024] [Indexed: 03/20/2024] Open
Abstract
Introduction Photoimmunotherapy (PIT) is a treatment wherein intravenous cetuximab sarotalocan sodium is administered followed by laser light irradiation. This treatment exhibits a specific antitumor effect if in tumors expressing the epidermal growth factor receptor, regardless of the carcinoma [Mitsunaga et al.: Nat Med. 2011;17(12):1685-91, Sato et al.: ACS Cent Sci. 2018;4(11):1559-69, Nakajima et al.: Cancer Sci. 2018;109(9):2889-96]. The current indications are unresectable, locally advanced, or locally recurrent head and neck cancer. If standard treatments, such as radiotherapy and chemotherapy, are available, they are given priority. However, a significant concern in PIT is the occurrence of airway emergencies related to pharyngeal edema. Prophylactic tracheostomy is often performed in cases of PIT involving the root of the tongue, hypopharynx, or larynx. Case Presentation In this study, we administered transoral PIT to a patient diagnosed with radiation-induced nasopharyngeal carcinoma (squamous cell carcinoma (SCC) cT1N0M0 stage I). Although previous case reports and our own experiences did not report airway emergencies following PIT for nasopharyngeal carcinoma, a unique case occurred in our study [Omura et al.: Auris Nasus Larynx. 2023;50(4):641-5, Kushihashi et al.: Int J Otolaryngol Head Neck Surg. 2022;11(5, Sep):258-65]. The patient experienced poor oxygenation and a decreased level of consciousness early in the morning following the laser irradiation. Nasal endoscopy revealed airway narrowing due to upper airway edema, and intubation was challenging. Consequently, we performed emergency bedside tracheostomy and the patient's condition improved. Conclusion Therefore, it is crucial to note that airway emergencies can be life-threatening and should be diligently monitored as a potential complication of PIT.
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Affiliation(s)
- Yukiomi Kushihashi
- Head and Neck Oncology Center, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Tatsuo Masubuchi
- Head and Neck Oncology Center, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Isaku Okamoto
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Chihiro Fushimi
- Head and Neck Oncology Center, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Morio Yamazaki
- Head and Neck Oncology Center, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Hisashi Asano
- Head and Neck Oncology Center, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Reo Aoki
- Head and Neck Oncology Center, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Shota Fujii
- Head and Neck Oncology Center, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Yukiko Asako
- Head and Neck Oncology Center, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
| | - Yuichiro Tada
- Head and Neck Oncology Center, International University of Health and Welfare, Mita Hospital, Tokyo, Japan
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Bajad P, Pahuja S, Agarwal S, Khanna A. Swiss Cheese Trachea: An Unwarranted, Unique Form of Post-intubation Tracheal Stenosis. Indian J Crit Care Med 2024; 28:84-85. [PMID: 38510770 PMCID: PMC10949288 DOI: 10.5005/jp-journals-10071-24611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/22/2024] Open
Abstract
How to cite this article: Bajad P, Pahuja S, Agarwal S, Khanna A. Swiss Cheese Trachea: An Unwarranted, Unique Form of Post-intubation Tracheal Stenosis. Indian J Crit Care Med 2024;28(1):84-85.
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Affiliation(s)
- Pradeep Bajad
- Department of Pulmonary Medicine, School of Medicine, Amrita Vishwa Vidyapeetham, Faridabad, Haryana, India
| | - Sourabh Pahuja
- Department of Pulmonary Medicine, School of Medicine, Amrita Vishwa Vidyapeetham, Faridabad, Haryana, India
| | - Satyam Agarwal
- Department of Pulmonary Medicine, School of Medicine, Amrita Vishwa Vidyapeetham, Faridabad, Haryana, India
| | - Arjun Khanna
- Department of Pulmonary Medicine, School of Medicine, Amrita Vishwa Vidyapeetham, Faridabad, Haryana, India
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Malkoc A, Wong S, Gnanadev R, Phan A, Farrokhi H, Nguyen DT, Wong DT. Tracheal ulcer development from high volume, low-pressure cuffed endotracheal tubes. Am J Otolaryngol 2024; 45:104098. [PMID: 37979216 DOI: 10.1016/j.amjoto.2023.104098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 10/29/2023] [Indexed: 11/20/2023]
Abstract
INTRODUCTION Iatrogenic injury to the larynx, particularly the vocal cords from prolonged intubation, has been well-studied; however, tracheal injuries are rarely reported. This study investigates the effectiveness of cuffed, high-volume, low-pressure endotracheal tubes in preventing the development of tracheal ulcers in intubated subjects. METHODS A retrospective, IRB-approved review was performed on 1355 subjects who underwent percutaneous tracheostomy from 2002 to 2018. The presence and severity of tracheal ulcers were collected using documentation and photos during percutaneous tracheostomy placement. Primary outcome measures included: the length of time on a ventilator until tracheostomy (LOVT), length of hospitalization (LOH), and mortality in relationship to the severity of the tracheal injury. Data was reported as n (%) and median (IQR). The differences in means between groups were analyzed by ANOVA and Chi-square test with an alpha of 0.05. RESULTS 206 subjects met the inclusion criteria; 65 subjects had an absence of tracheal injury, and 141 subjects developed tracheal ulcers. Subjects with tracheal ulcers were grouped by the following severity scale: no ulcer; mild ulcer (minimal mucosal erosion with exudate); moderate ulcer (mucosal erosion); and severe (tracheal ring exposure). There were no statistically significant differences in age (p = 0.99), gender (p = 0.83), BMI (p = 0.44), LOH (p = 0.88), LOVT (p = 0.93), and mortality (p = 0.306) between subjects with differing severity of ulcers. The average annual incidence of clinically significant ulcers (moderate and severe) was 2.2 %. CONCLUSIONS The lack of statistical correlation between the duration of intubation and tracheal ulcer severity, along with a low annual incidence of tracheal ulcers, supports the improved safety of high-volume, low-pressure cylindrical, cuffed endotracheal tubes. This study is among the first to specifically focus on injuries at the level of the cuff and tip of endotracheal tubes with implications in preventive measures and potential product design changes.
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Affiliation(s)
- Aldin Malkoc
- Arrowhead Regional Medical Center, 400 N Pepper Ave, Colton, CA 92324, USA
| | - Stephanie Wong
- Arrowhead Regional Medical Center, 400 N Pepper Ave, Colton, CA 92324, USA; California University of Science and Medicine, 1501 Violet Street, Colton, CA 92324, USA
| | - Raja Gnanadev
- Arrowhead Regional Medical Center, 400 N Pepper Ave, Colton, CA 92324, USA
| | - Alexander Phan
- Arrowhead Regional Medical Center, 400 N Pepper Ave, Colton, CA 92324, USA
| | - Haley Farrokhi
- University of California, Los Angeles, Los Angeles, CA 90095, USA
| | - Danny T Nguyen
- Arrowhead Regional Medical Center, 400 N Pepper Ave, Colton, CA 92324, USA
| | - David T Wong
- Arrowhead Regional Medical Center, 400 N Pepper Ave, Colton, CA 92324, USA.
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Chan HE, Lim JY, Fazlina AH, Zhao L, Feng Q, Lim PQ, Ng LSY, Lim YY, Tan PT, Tan SH, Koo SH, Neo SK, Tan AKL, Chandran R, Lu PKS. Evaluation of the microbiological efficacy of cleaning agents for tracheostomy inner cannulas. Am J Otolaryngol 2024; 45:104073. [PMID: 37862880 DOI: 10.1016/j.amjoto.2023.104073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Accepted: 09/26/2023] [Indexed: 10/22/2023]
Abstract
PURPOSE Biofilms are a significant cause of morbidity in patients with indwelling medical devices. Biofilms pose a potential risk with reusable inner cannulas by increasing the risk of infections. Effective decontamination is thus vital in decreasing bioburden. The current guidelines for cleaning inner cannulas are varied, with multiple techniques being recommended, which are not supported by strong evidence. This randomized, controlled, cross-over study attempted to enumerate the bacterial count of inner cannulas used in tracheostomy patients (n = 60) pre-and post-decontamination with detergent (A) or sterile water (B). MATERIALS AND METHODS The patients were randomly allocated to sequence A > B or B > A in 1:1 fashion. The saline flushing of the inner cannulas was plated on trypticase soy agar with 5 % sheep blood to enumerate the bacterial count. RESULTS The mean ratio [Log (CFU)post/Log (CFU)pre]A/[Log (CFU)post/Log (CFU)pre]B based on 53 samples was 0.918 ± 0.470, two-sided 90 % confidence interval (CI) 0.812, 1.024. The equivalence criterion was met as the mean ratio after cleaning fell within the equivalence region of 0.8 and 1.25. CONCLUSION This study demonstrated the microbiological efficacy of both detergent and sterile water in the decontamination of inner cannulas, and that sterile water was not less effective than detergent in reducing the bacterial load for safe re-use of inner cannulas. This has the potential to promote cost savings for patients with tracheostomy, both in the hospital and the community. The study findings may also be relevant in formulating tracheostomy care policies. LEVEL OF EVIDENCE: 1
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Affiliation(s)
- Hong Eng Chan
- Department of Nursing, Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | - Jia Yan Lim
- Department of Nursing, Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | - Abdul Hathi Fazlina
- Department of Nursing, Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | - Liping Zhao
- Department of Nursing, Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | - Qi Feng
- Department of Nursing, Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | - Pei Qi Lim
- Clinical Trials and Research Unit, Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | - Lily Siew Yong Ng
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | | | - Pei Ting Tan
- Clinical Trials and Research Unit, Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | - Si Huei Tan
- Department of Laboratory Medicine, Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | - Seok Hwee Koo
- Clinical Trials and Research Unit, Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | - Soon Keow Neo
- Department of Nursing, Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | - Alvin Kah Leong Tan
- Department of Otorhinolaryngology- Head and Neck Surgery, Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | - Rajkumar Chandran
- Department of Anaesthesia and Surgical Intensive Care, Changi General Hospital, 2 Simei Street 3, 529889, Singapore.
| | - Peter Kuo Sun Lu
- Department of Otorhinolaryngology- Head and Neck Surgery, Changi General Hospital, 2 Simei Street 3, 529889, Singapore
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Wulandari DP, Khoiria AH, Latifa EF. Transoral Endoscopic-Assisted Resection of Laryngeal Schwannoma: A Case Report. Iran J Otorhinolaryngol 2024; 36:371-375. [PMID: 38259691 PMCID: PMC10800143 DOI: 10.22038/ijorl.2023.71324.3427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 12/20/2023] [Indexed: 01/24/2024]
Abstract
Introduction Schwannoma, a peculiar benign nerve sheath tumour, is frequently hard to differentiate from other nerve tumours, such as neurofibroma. Around 25%-45% of all schwannomas emerge in the head and neck region, but only 0.1-1.5 % involve laryngeal structure. This tumour is most accurately diagnosed with biopsy via direct laryngoscopy; however, at some points this approach cannot detect a definitive diagnosis due to the surrounding capsule of the tumour and its similar histopathologic finding with other nerve sheath tumour. Case Report Here, a case of 56-year-old female is reported with chief complaints of severe progressive dyspnea and dysphagia. Diagnosis of schwannoma was confirmed on radiological and histopathological examination with certain hurdles. A complete surgical excision via endoscopic approach was done, revealing that the bottom of the mass was attached to the right arytenoid mucosa. The histopathological features showed non-malignant atypical neurofibroma but later confirmed as laryngeal schwannoma from immunohistochemical staining. Conclusion Although schwannoma has an excellent outcome and prognosis when occurring elsewhere in the body, laryngeal involvement is an extremely rare area for this lesion. Complete resection with a patient-customized approach to the lesion is required to avoid relapses and provide good functional results.
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Affiliation(s)
- Dian Paramita Wulandari
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Anisa Haqul Khoiria
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
| | - Elida Fadhilatul Latifa
- Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia.
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Belding E, Kanotra SP. Single stage pediatric airway reconstruction in solid organ transplant recipients. Int J Pediatr Otorhinolaryngol 2024; 176:111804. [PMID: 38039803 DOI: 10.1016/j.ijporl.2023.111804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Revised: 11/17/2023] [Accepted: 11/21/2023] [Indexed: 12/03/2023]
Abstract
OBJECTIVES To describe results of single stage laryngotracheal reconstruction (ssLTR) in patients with solid organ transplants and to discuss modifications which need to be considered in this subset of patients pre-operatively, intra-operatively and post-operatively. STUDY DESIGN We performed a retrospective case series review of children undergoing single stage laryngotracheal reconstruction in the context of prior solid organ transplant. SETTING A tertiary care academic setting. METHODS Pediatric cases undergoing Laryngotracheal reconstruction over a 3-year period. Demographic data including age, sex, presenting symptoms, operative details. RESULTS Two cases of ssLTR in solid organ transplant patients were found, one each with renal and cardiac transplants respectively. Both patients successfully underwent ssLTR for Grade 2 subglottic stenosis. The care of these patients was multidisciplinary and required alterations in their preoperative prophylactic antibiotics. While they did not require changes to the LTR post-operative sedation protocol, their immunosuppressant doses and target ranges were lowered. Special care was taken to avoid nephrotoxic and cardiotoxic medications throughout their hospital stay. CONCLUSIONS Although traditionally considered for double stage laryngotracheal reconstruction, single stage laryngotracheal reconstruction is a viable option in patients with solid organ transplant. These patients require a multidisciplinary approach and pharmacological protocol alterations pre-, intra-, and post-operatively.
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Affiliation(s)
- Emily Belding
- University of Iowa Hospitals and Clinics, Department of Otolaryngology- Head and Neck Surgery, 200 Hawkins Drive, Iowa City, IA, 52242, USA
| | - Sohit Paul Kanotra
- University of Iowa Hospitals and Clinics, Department of Otolaryngology- Head and Neck Surgery, 200 Hawkins Drive, Iowa City, IA, 52242, USA; University of California Los Angeles, Department of Otolaryngology- Head and Neck Surgery, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, CHS 62-132, Los Angeles, CA, 90095-1624, USA.
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Nguyen A, Rajski B, Furey V, Duffner L, Young B, Husain IA. Upper airway and tracheostomy management in patients with COVID-19: A long-term acute care hospital (LTACH). Am J Otolaryngol 2024; 45:104029. [PMID: 37659226 DOI: 10.1016/j.amjoto.2023.104029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2023] [Accepted: 08/17/2023] [Indexed: 09/04/2023]
Abstract
OBJECTIVE Describe the tracheostomy and ventilation management of patients admitted due to COVID-19 as facilitated by speech language pathologists (SLPs) and otolaryngologists within the long-term acute care hospital (LTACH) setting. STUDY DESIGN Retrospective cohort study. SETTING Long-term acute care hospital. SUBJECTS AND METHODS A retrospective chart review was conducted on all patients admitted to RML Specialty Hospital for respiratory failure secondary to COVID-19 from April 1, 2020 to November 30, 2021. Demographic information, laryngeal findings, and tracheostomy management was reviewed. Descriptive statistics and chi-square analysis were performed. RESULTS Amongst the 213 subjects, 80.0 % arrived on mechanical ventilation. 23.0 % required otolaryngology consultation during LTACH stay due to poor Passy Muir Valve (PMV) or tracheostomy capping tolerance. 35 (71.4 %) of those consulted had abnormal laryngeal findings on exam with subglottic/tracheal stenosis and laryngeal edema being most common at 38.8 % and 20.4 %, respectively. 28.6 % of those with laryngeal findings were decannulated by discharge. Mechanical ventilator weaning and decannulation success were 86.6 % and 62.5 %, respectively. No association (p > 0.05) between number of intubations and abnormal laryngeal findings were found. No association (p > 0.05) between number of intubations or prone-positioning and decannulation success at discharge were found. CONCLUSION LTACHs can serve a specific role in upper airway rehabilitation and tracheostomy care in the post COVID-19 period. SLPs and otolaryngologists should be involved in the care of these patients to help facilitate decannulation and return to normal laryngeal function.
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Affiliation(s)
- Alvin Nguyen
- University of Illinois at Chicago College of Medicine, Chicago, IL, United States of America.
| | - Barbara Rajski
- RML Specialty Hospital - Department of Rehabilitation, Hinsdale, IL, United States of America
| | - Vicki Furey
- RML Specialty Hospital - Department of Rehabilitation, Hinsdale, IL, United States of America
| | - Lisa Duffner
- RML Specialty Hospital - Office of Clinical Research, Hinsdale, IL, United States of America
| | - Bryce Young
- Midwestern University Chicago of Osteopathic Medicine, Downers Grove, IL, United States of America
| | - Inna A Husain
- Community Hospital, Department of Otolaryngology, Munster, IN, United States of America
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Villasenor M, Bengson J, Cloyd BH, Eckle T. Cardiac arrest due to an unexpected inability to ventilate in a tracheostomy patient suggesting the need for a routine anesthesia checklist and an anesthesia relevant emergency pathway for tracheostomy management: a case report. Ann Transl Med 2023; 11:420. [PMID: 38213806 PMCID: PMC10777221 DOI: 10.21037/atm-23-1834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 11/11/2023] [Indexed: 01/13/2024]
Abstract
Background Up to 30% of patients worldwide have a significant complication related to their tracheostomy. We report a case of a 'cannot ventilate' event resulting in cardiac arrest due to an unexpected airway occlusion in a patient with a pre-existing brain injury The following case report is unique as the patient had developed a mucus plug that turned into a crystal following a coronavirus disease 19 (COVID-19) infection. Case Description The patient was a young adult who suffered a traumatic brain injury from a motor vehicle collision. He presented for elective cystoscopy to treat recurrent urinary tract infections. During induction of anesthesia, the patient became agitated, desaturated, and ventilation became impossible. With chest compressions underway the tracheostomy was removed, and the patient was quickly and successfully orally intubated using a video-laryngoscope. Subsequent inspection of the tracheostomy tube revealed a mucus plug in the distal portion which had hardened into a rock-like appearance. The inner cannula was also missing. Follow-up revealed that the patient recently had a COVID-19 infection and because of this received less frequent suctioning of his tracheostomy tube. Conclusions Reviewing the literature, we recognized that there has been no case report documenting a mucus plug that turned into a stone. Reviewing guidelines for handling tracheostomy emergencies, we recognize that there are no anesthesia specific guidelines in the USA. We also recognize that there are no established checklists for patients with tracheostomy undergoing surgery. We therefore recommend establishing a routine checklist and anesthesia specific guideline for emergencies that follows every patient with a tracheostomy undergoing surgery.
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Affiliation(s)
- Mario Villasenor
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Jeremy Bengson
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Benjamin H Cloyd
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Tobias Eckle
- Department of Anesthesiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA
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Evans H. Waterless bathing for inpatients with neurological issues and complex needs. Br J Nurs 2023; 32:1092-1097. [PMID: 38060392 DOI: 10.12968/bjon.2023.32.22.1092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2023]
Abstract
Waterless bathing techniques can enhance the care of patients with neurological difficulties. Traditional methods can be uncomfortable and time consuming. Hospital-acquired infections in the NHS are a significant concern because of both financial burdens and antibiotic resistance, and preventing them is paramount. ContiTM waterless bathing products help reduce infection risks, save time and improve the patient experience. Four case studies illustrate the application of these techniques in a specialist hospital for people with complex and serious neurological conditions, demonstrating their practicality and efficacy as well as improvements in patient care and infection control within healthcare facilities.
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Affiliation(s)
- Helen Evans
- Senior Staff Nurse and Tissue Viability Specialist, Holy Cross Hospital, Haslemere, Surrey
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